Procalcitonin as a Diagnostic Aid in Osteomyelitis and Septic Arthritis

Butbul-Aviel, Yonatan; Koren, Ariel; Halevy, Raphaël; Sakran, Waheeb

doi:10.1097/01.pec.0000190226.12610.24

Cited by 97 publications

(75 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may be attributed to the fact that joint SA, RA, OA and GA do not cause systemic inflammation; therefore, serum levels of PCT are unable to differentiate SA from RA, OA and/or GA. Certain studies have demonstrated that low levels of PCT may result from limited inflammation or early infection (41,42). Other studies have revealed that the lack of a systemic inflammatory response causes the sensitivity of serum PCT in the differential diagnosis of infectious prosthesis to be extremely low (38–40).…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis

Wang

Zhong

Liao

et al. 2014

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Whether the levels of procalcitonin (PCT) in the serum and synovial fluid are effective indicators for distinguishing septic arthritis (SA) from non-infectious arthritis remains controversial. The present study aimed to evaluate whether PCT levels in fresh serum or fresh joint fluid may be used in the differential diagnosis of SA from rheumatoid arthritis (RA), osteoarthritis (OA) and gouty arthritis (GA). From January 2012 to June 2013, 23 patients with knee SA, 21 patients with RA, 40 patients with OA and 11 patients with GA were enrolled in the current study. The levels of PCT were measured within 24 h after specimen collection at room temperature. An enzyme-linked fluorescence assay (ELFA) was used to detect the levels of PCT in the serum and synovial fluid. The correlations between the levels of PCT in the serum and synovial fluid and the arthritic patient groups were determined by the Nemenyi test. Areas under the receiver operating characteristic (ROC) curve were calculated to evaluate the accuracy of the correlations. The levels of PCT in the serum and joint fluid of the patients in the SA group were higher compared with those of the other groups (P<0.01) and there were no significant differences among the RA, OA and GA groups in these levels. A PCT level of <0.5 μg/l in the serum and synovial fluid had high specificity in the differential diagnosis of SA from RA, OA and GA. Synovial fluid PCT revealed significantly greater sensitivity than serum PCT. The accuracy of the differential diagnosis of SA by the serum levels of PCT was significantly lower than that by the synovial fluid levels of PCT. The levels of PCT in the serum and synovial fluid may be used as alternative laboratory indicators to distinguish between SA and the non-infectious types of arthritis; however, the PCT levels in fresh synovial fluid are more sensitive and accurate indicators than PCT levels in fresh serum.

show abstract

Section: Discussionmentioning

confidence: 99%

Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis

Wang

Zhong

Liao

et al. 2014

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

show abstract

“…Some current investigators have been advocating the use of procalcitonin, another marker of inflammation, but we doubt if it adds anything to CRP, which is less expensive and easier and quicker to measure -a whole blood finger-prick sample suffices, and handy portable instruments for point-of-care tests are available. Furthermore, procalcitonin measurements might be inferior even to CRP, at least in SA [12,45]. Traditional ESR is useful in diagnostics, but normalizes too slowly to be a good yardstick in monitoring [12].…”

Section: Monitoring Recoverymentioning

confidence: 99%

Simplifying the treatment of acute bacterial bone and joint infections in children

Pääkkönen

Peltola

2011

Expert Review of Anti-infective Therapy

View full text Add to dashboard Cite

The treatment of acute hematogenous bone and joint infections of children - osteomyelitis (OM), septic arthritis (SA) and OM-SA combination (OM+SA) - has simplified over the past years. The old approach included months-long antibiotic treatment, started intravenously for at least a week, followed by oral completion of the course. Recent prospective randomized trials show that most cases heal with a total course of 3 weeks (OM, OM+SA) or 2 weeks (SA) of an appropriate antibiotic, provided the clinical response is good and C-reactive protein level has normalized. If the prevalence of methicillin-resistant Staphylococcus aureus and Kingella kingae is low, clindamycin and a first-generation cephalosporin are safe, inexpensive and effective alternatives. They should be administered in large doses and four times a day. Clindamycin, vancomycin and expensive linezolid are options against methicillin-resistant Staphylococcus aureus. Extensive surgery beyond a diagnostic sample by aspiration is rarely needed in uncomplicated cases.

show abstract

“…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.…”

Section: Laboratory Findingsmentioning

confidence: 99%

Neonatal Osteomyelitis

Kiechl‐Kohlendorfer¹,

Griesmaier²

2013

Neonatal Bacterial Infection

View full text Add to dashboard Cite

Procalcitonin as a Diagnostic Aid in Osteomyelitis and Septic Arthritis

Abstract: In this study, PCT was found to be a useful marker in the diagnosis of osteomyelitis and not in septic arthritis. A larger group of patients needed to be studied to confirm our findings.

Cited by 97 publications

References 24 publications

Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis

Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis

Simplifying the treatment of acute bacterial bone and joint infections in children

Neonatal Osteomyelitis

Contact Info

Product

Resources

About