Can procalcitonin measurement help the diagnosis of osteomyelitis and septic arthritis? A prospective trial

Abstract

Objectives: Procalcitonin (PCT) is an accurate marker for differentiating bacterial infection from non-infective causes of inflammation or viral infection. However, there is only one study in children which tested procalcitonin as a diagnostic aid in skeletal infections. With this study we sought to evaluate the sensitivity, specificity and predictive values of procalcitonin for identifying bone and joint infection in children evaluated in the emergency department for non traumatic decreased active motion of a skeletal segment. Methods:Patients aged 1 month to 14 years were prospectively included in the emergency department when suspected for osteomyelitis or septic arthritis. Procalcitonin levels, C reactiv protein, white blood cell count were measured and bacteriological samples were collected before initiation of antibiotic treatment. Patients were assigned to 3 groups according to the degree of suspected infection: group 1 confirmed infection, group 2 presumed infection and group 3 non infected patients.Results: Three hundred thirty nine patients were included (118 girls and 221 boys). Group 1 comprised 8 patients (2 had PCT levels > 0.5 ng/ml). Two had osteomyelitis and 6 septic arthritis. Forty children were incuded in group 2 (4 had PCT levels > 0.5 ng/ml). Eighteen had presumed osteomyelitis and 22 presumed septic arthritis. Group 3 comprised 291 children (9 PCT levels > 0.5 ng/ml) who recovered without antibiotic treatment. The specificity of the PCT as a marker of bacterial infection (comparing Group 1 and Group 3) was 96.9% [95% CI, Conclusion:PCT is not a good screening test for identifying skeletal infection in children. Larger studies are needed to evaluate still more the place of PCT measurements in the diagnosis of osteomyelitis and septic arthritis.

Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis

“…However, there is no unanimous agreement in deciding the cut – off because PCT is an emerging diagnostic marker and is either undetectable or very low in healthy individuals. Studies by Butbul Aviel et al, [10]; Fottner et al, [11]; Martinot et al, [13] and Faesh et al, [14] have taken 0.5 ng/ml as cut – off above which it is considered as a marker of pyogenic infection. However, study by Hogle et al, [12] has taken 0.25 ng/ml as the cut-off.…”

“…There is now enough evidence to support the role of Procalcitonin (PCT) as a diagnostic and prognostic marker in infective conditions with its very high specificity for bacterial infections [6-9]. On the contrary, there are only very few studies evaluating its efficacy in Septic Arthritis (SA) and Acute Osteomyelitis (OM) with varying results [10-14]. Serum levels of Procalcitonin is very low in healthy individuals (< 0.1 ng/ml) and increases rapidly in response to bacterial endotoxin [15,16].…”

Neonatal Osteomyelitis

“…The C-reactive protein (CRP) is a rapid indicator of systemic inflammation and tissue damage, is useful as acute phase reactant, but not specific for skeletal infection. Procalcitonin has also been described as a potential marker in the diagnosis of osteomyelitis in children, but needs to be investigated in larger trials, especially in newborns [31,32]. Elevated values of CRP and erythrocyte sedimentation rates could be used to monitor response to therapy or identify complications.…”

Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study

“…This is on par with the findings of Faesch and his co-workers who reported the same in their study. 14 The results of this group show that PCT and CRP levels are lower in non infectious causes than in cases of bacterial infections.…”