Sensitivity and specificity of serum procalcitonin level compared to leucocyte count for diagnosis of surgical site infection on patients undergoing major surgery

Abstract

Surgical site infection (SSI) is one of the most serious complications on sugical procedure. However, its diagnosis is still based on the clinical and laboratory examination that take more time and less sensitive and specific. Therefore, early diagnosis that is more accurate and precise is needed. Some biomarker such as serum procalcitonin (PCT) is promoted for diagnosis SSI. The aim of the study was to evaluate the sensitivity and specificity of serum PCT compared with leucocyte for diagnosis of SSI on patients undergoing major surgery. This was a descriptive analytical study with a prospective observational design. Patients who underwent a major surgery between October 30 th and December 31 st , 2011 and fulfilled the inclusion and exclusion criteria were recruited. Clinical and laboratory examinations including leucocyte count were conducted presurgery. On 3 rd day postsurgery, blood sample was taken for PCT and leucocyte count measurement. A blood bacterial culture was performed on patients suffering from SSI according to Centers for Disease Control (CDC) criteria. Patients were then followed until 30 days postsurgery. A total of 49 patients consisting of 22 men and 27 women were involved in this study. Surgical site infection was found in 16 patients consisting of 8 (50%) patients with clean surgical wound, 3 (19%) patients with clean surgical contamination wound, 4 (25%) patients with surgical contamination wound and 1 (6%) patient with dirty surgical wound. Furthermore, laboratory examination found that 9 patients had abnormal leucocyte with 6 of them suffering from SSI, whereas from 15 patients with serum PCT abnormal, and 11 patients suffered from SSI. Diagnostic test showed that the sensitivity and specificity of serum PCT for diagnosis of SSI were 68.75 and 90.90%, respectively, whereas the sensitivity and specificity of leucocyte were 31.25 and 87.87%, respectively. In conclusion, serum PCT has better sensitivity and specificity compared with leucocyte for the diagnosis of SSI in patients with major surgery. ABSTRAKInfeksi luka operasi (ILO) merupakan salah satu komplikasi paling serius pada pembedahan. Namun demikian, diagnosis ILO masih bedasarkan pemeriksaan klinik dan laboratorium yang butuh waktu lama dan kurang sensitif maupun spesifik. Oleh karena itu, diagnosis dini yang lebih akurat dan tepat diperlukan. Beberapa biomarker seperti kadar prokalsitonin (PCT) dipromosikan untuk diagnosis SSI. Penelitian ini bertujuan untuk mengkaji sensitivitas dan spesifisitas PCT serum dibandingkan leukosit untuk diagnosis ILO pada pasien yang menjalani bedah mayor. Penelitian ini merupakan penelitian deskriptif analitik dengan rancangan observasional prospektif. Pasien yang menjalani bedah mayor antara 30 Oktober dan 31 Desember 2011 dan memenuhi kriteria inklusi dan eksklusi dilibatkan dalam penelitian. Hari ke 3 setelah 19%) pasien dengan luka operasi bersih kontaminasi, 4 (25%) pasien dengan luka operasi kontaminasi dan 1 (6%) pasien dengan luka operasi kotor. Pada pemeriksaan laboratorium dite...