Inflammatory Blood Laboratory Levels as Markers of Prosthetic Joint Infection

Berbari, Elie F.; Mabry, Tad M.; Tsaras, Geoffrey; Spangehl, Mark J.; Erwin, Pat; Murad, M. Hassan; Steckelberg, James M.; Osmon, Douglas R.

doi:10.2106/jbjs.i.01199

Cited by 379 publications

(253 citation statements)

References 26 publications

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“…This may cause some uncertainty regarding how the constellation of unknown and known factors could have biased our results. Finally, other useful diagnostic modalities, such as leukocyte esterase, IL-6, sonication of explanted prosthesis, and PCR, remain potential diagnostic tools for PJI [4,11,22,28,30,38]. Therefore, the MSIS definition can be subject to future modifications, as are the thresholds for any criteria within new combinational algorithms.…”

Section: Discussionmentioning

confidence: 99%

“…Despite a considerable volume of literature, the appropriate thresholds are still unclear. Thresholds of 12 to 40 mm/hour for ESR and 3 to 13.5 mg/L for CRP have been proposed, with no distinction being made between PJI occurring in knees versus hips or late versus early infection [4]. This wide range of thresholds makes use of ESR and CRP confusing for PJI diagnosis at least for the purpose of uniform research.…”

Section: Introductionmentioning

confidence: 99%

“…This wide range of thresholds makes use of ESR and CRP confusing for PJI diagnosis at least for the purpose of uniform research. The MSIS suggests the conventional thresholds of 30 mm/hour and 10 mg/L for ESR and CRP, respectively, which were selected arbitrarily due to lack of studies determining the threshold [4,9,20,24,34,36].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

117

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Background Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. Questions/purposes Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. Methods We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. Results ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. Conclusions The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

117

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“…However, it is not obvious how much additional information this test provides beyond commonly available tests. For example, when tested individually, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid cell count do not perform as well as the alpha-defensin assay [1], but a combination of those tests, does yield high sensitivity and specificity [9,10]. The alpha-defensin threshold level for diagnosing an acute periprosthetic infection (within three months of arthroplasty) has not yet been established, nor has the test been validated for other types of orthopaedic infections.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

CORR Insights®: How Reliable Is the Alpha-Defensin Immunoassay Test for Diagnosing Periprosthetic Joint Infection? A Prospective Study

Bauer

2017

Clinical Orthopaedics &Amp; Related Research

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“…The more accurate the diagnostic evaluation is before revision, the greater the success rate. A thorough evaluation should include a complete history, physical examination, radiographs, measurement of serum levels of C-reactive protein, synovial fluid aspiration with cell count and differential, and use of aerobic and anaerobic cultures [1,3,18]. Despite clinicians' efforts, the diagnosis of a low-grade infection sometimes may be missed before revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

Bedenčič

Kavčič

Faganeli

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions. Questions/purposes We wished to determine whether administration of preoperative antibiotics decreases the likelihood of diagnosing PJI in patients undergoing revision hip or knee arthroplasty in whom infection is suspected. Methods We prospectively enrolled and evaluated 40 patients (29 with THAs and 11 with TKAs) who met the following inclusion criteria: older than 18 years, with suspected PJI of unknown cause, undergoing surgical revision. After arthrotomy, three tissue samples were obtained for microbiologic analysis and diagnosis, and antimicrobial prophylaxis (cefazolin 2 g intravenously) then was administered. Later during the procedure, but before débridement and irrigation, the second set of three tissue samples was obtained from the same surgical area and was cultured. Tissue concentration of prophylactic antibiotic was verified with the second set of samples. A positive culture result was defined as one or more positive cultures (growth on agar at or before 14 days). We then compared the yield on the microbiologic cultures obtained before administration of antibiotics with the yield on the cultures obtained after antibiotics were administered. An a Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. priori analysis was performed; with the numbers available, we had 98% power to detect a difference in diagnostic sensitivity of 33%. Results With the numbers available, we found no difference in the likelihood that an infection would be diagnosed between the samples obtained before and after administration of antimicrobial prophylaxis...

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Inflammatory Blood Laboratory Levels as Markers of Prosthetic Joint Infection

Cited by 379 publications

References 26 publications

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

CORR Insights®: How Reliable Is the Alpha-Defensin Immunoassay Test for Diagnosing Periprosthetic Joint Infection? A Prospective Study

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

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