Diagnostic test accuracy of serum measurement of procalcitonin and C-reactive protein for bone and joint infection in children and adolescents

Ritchie, Brett; Porritt, Kylie; Marín, Tania; Williams, Nicole

doi:10.11124/jbisrir-d-19-00139

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…Studies [ 13 , 14 ] showed that its biological function may be to clear pathological substances or pathogens from the body by binding to phospholipid components of apoptotic and necrotic cells or invading bacteria, fungi, parasites and other pathogens and activating the complement and mononuclear phagocyte systems. Studies [ 15 , 16 ] have shown that serum concentrations are below 10 mg/L in normal subjects, but in patients with severe infections or sepsis, CRP concentrations rise rapidly 6 hours after the onset of stimulation and reach a maximum within approximately 48 hours, with concentrations decreasing rapidly and returning to normal within 1 week, whereas concentrations do not increase in virally infected individuals, but this also provides an extremely important basis for determining the type of early infection The basis for this study was the following.…”

Section: Introductionmentioning

confidence: 99%

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis

2022

Emergency Medicine International

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Objective. The aim of the study is to analyze the clinical characteristics, pathogen distribution, and drug sensitivity information of adult sepsis, and to provide reference for empirical clinical use; to explore the relationship between C-reactive protein (CRP) and calcitonin (PCT) The clinical value in the diagnosis of adult sepsis. Methods. We collected 455 cases of hospitalized patients with positive blood culture, including 352 cases with sepsis and 103 cases without sepsis; 1609 cases of hospitalized patients with suspected infection and negative blood culture, including 287 cases of sepsis, and 518 cases of non-infectious systemic inflammatory response syndrome (SIRS) and 804 cases of local infection. Age, gender, route of admission, admission status, CRP, PCT, and white blood cell (WBC) levels were collected from the patients. The differences between the factors were statistically analyzed, and the receiver operating characteristic curve (ROC curve) was plotted to obtain the optimal cut-off values of CRP and PCT and their area under the curve (AUC), and to compare the CRP, PCT and PCT, and the CRP + PCT tandem to diagnose sepsis sensitivity and specificity. Results. (1) 387 pathogenic strains were isolated from blood cultures of patients with sepsis, 71.06% Gram-negative, 26.87% Gram-positive and 2.07% fungi. (2) Among Gram-positive bacteria, Staphylococcus aureus was 87.5% resistant to penicillin and sensitive to vancomycin, milantropine, and teicoplanin; among Gram-negative bacteria, Escherichia coli was resistant to piracillin The resistance rate was 73.1%, fully susceptible to viraemia (100%) and resistant to imipenem, amikacin, and lacillin/tazole. (3) Among patients with positive blood cultures, CRP and PCT levels were higher in patients with sepsis than in those without sepsis. Pairwise comparison of ROC curves showed that the diagnostic value of PCT was greater than that of CRP ( P = 0.016 ). Conclusion. CRP and PCT have a good reference value for diagnosis of sepsis patients and determination of the degree of infection in septic patients, especially PCT is more valuable for diagnosis of sepsis.

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Section: Introductionmentioning

confidence: 99%

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis

2022

Emergency Medicine International

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“…PCT and C-reactive protein are significantly correlated with the severity of bone infection, but only PCT can distinguish whether it is a complex infection (Vangaveti et al, 2021). A systematic review and analysis have shown that serum PCT is a sensitive detection method for diagnosing adult osteoarticular infection (Ertugrul et al, 2009;Ritchie et al, 2020). In the current study, PACT and PACT combined with an antibiotic obviously reduced the PCT content in serum and alleviated the inflammatory reaction caused by osteomyelitis.…”

Section: Discussionmentioning

confidence: 51%

Antimicrobial Photodynamic Therapy Involving a Novel Photosensitizer Combined With an Antibiotic in the Treatment of Rabbit Tibial Osteomyelitis Caused by Drug-Resistant Bacteria

et al. 2022

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Osteomyelitis is deep tissue inflammation caused by bacterial infection. If such an infection persists, it can lead to dissolution and necrosis of the bone tissue. As a result of the extensive use of antibiotics, drug-resistant bacteria are an increasingly common cause of osteomyelitis, limiting the treatment options available to surgeons. Photodynamic antibacterial chemotherapy has attracted increasing attention as a potential alternative treatment. Its advantages are a broad antibacterial spectrum, lack of drug resistance, and lack of toxic side effects. In this study, we explored the impact of the new photosensitizer LD4 in photodynamic antimicrobial chemotherapy (PACT), both alone and in combination with an antibiotic, on osteomyelitis. A rabbit tibial osteomyelitis model was employed and microbiological, histological, and radiological studies were performed. New Zealand white rabbits (n = 36) were randomly divided into a control group, antibiotic group, PACT group and PACT + antibiotic group for treatment. In microbiological analysis, a reduction in bacterial numbers of more than 99.9% was recorded in the PACT group and the PACT + antibiotic group 5 weeks after treatment (p < 0.01). In histological analysis, repair of the damaged bone tissue was observed in the PACT group, and bone repair in the PACT + antibiotic group was even more significant. In radiological analysis, the X-ray Norden score showed that the severity of bone tissue defects or destruction followed the pattern: PACT + antibiotic group < PACT group < antibiotic group < control group.

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“…Developmental immaturity of the immune system, variations in specificity and sensitivity values of each reactant across studies, type and virulence of causative microorganism, type of joint – hip versus knee – and previous antibiotic intake may alter their diagnostic utility. 5 , 18 , 28 – 36 Nonetheless, a recent study suggested that synovial fluid cell count of polymorphonuclear leukocyte is not influenced by intake of antibiotics prior to aspiration of various joints. 37 Another reported excellent positive and negative predictive values of leukocyte esterase strip test on synovial fluid to aid the diagnosis of septic arthritis in children.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…Surprisingly, children with transient synovitis of the hip usually maintain a fair level of daily activities, in remarkable contrast to those with established AOI. 19 , 27 , 28 , 48 A misdiagnosis of AOI for transient synovitis of the hip could result in failure to institute a timely management plan with subsequent lifelong disabling sequels. 18 , 25 Scurvy is a rare nutritional disorder caused by longstanding vitamin C deficiency.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

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Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

El-Sobky

Mahmoud

2021

EFORT Open Reviews

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Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis. A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management. Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician’s clinical judgment. Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve. The growing body of evidence on ‘high-risk’ children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets. Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis. Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155

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Diagnostic test accuracy of serum measurement of procalcitonin and C-reactive protein for bone and joint infection in children and adolescents

Cited by 5 publications

References 23 publications

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis

Antimicrobial Photodynamic Therapy Involving a Novel Photosensitizer Combined With an Antibiotic in the Treatment of Rabbit Tibial Osteomyelitis Caused by Drug-Resistant Bacteria

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

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