C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections
C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections
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DOI：
10.1007/s00264-017-3430-5
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发表时间：
2017-07-01
影响因子：
2.7
通讯作者：
Monllau, Joan C.
中科院分区：
文献类型：
--
作者：
Perez-Prieto, Daniel;Portillo, Maria E.;Monllau, Joan C.
假体周围组织培养，超声和滑液培养仍然是假体关节感染（PJI）诊断的金标准。然而，仍有15-20%的PJI培养阴性的报道。因此，需要其他的诊断标准。关于PJI的不同定义值得关注的一点是，将c反应蛋白（CRP）和红细胞沉降率（ESR）纳入PJI的诊断标准，尽管它们是非特异性炎症性血液检查。目的探讨CRP与ESR在PJI诊断中的相关性。方法回顾性分析两所医院两年内所有培养阳性的PJI。本研究的主要变量为假体类型和CRP水平。在那些CRP正常的患者中记录了更多的信息：x线片、体格检查记录和ESR。结果共纳入73例患者。23例患者术前CRP水平正常（低于0.8 mg/dl），占所有PJI阳性培养的32%。低毒力微生物，凝血酶阴性葡萄球菌12株，痤疮假单胞菌4株。他们占所有CRP水平正常的PJI的70%。此外，17例患者（占所有培养阳性PJI患者的23%）ESR正常，体格检查正常（仅表现为疼痛），x线片未观察到明显松动。根据美国骨科医师协会（AAOS）指南或肌肉骨骼感染学会（MSIS），本研究中23%的PJI患者从未被确诊。血液炎症标志物如CRP水平和ESR作为PJI的诊断工具可能不准确，特别是在识别低级别和慢性PJI时。
Background Periprosthetic tissue cultures, sonication and synovial fluid cultures remain the gold standard for prosthetic joint infection (PJI) diagnosis. However, some 15-20% culture-negative PJI are still reported. Therefore, there is the need for other diagnostic criteria. One point of concern relative to the different definitions of PJI is as to the inclusion of the c-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) as diagnostic criteria for PJI despite them being non-specific inflammatory blood tests.Purpose The purpose of the present study was to determine the relevance of CRP and the ESR in the diagnosis of PJI.Methods All PJI with positive cultures over a two-year period in two hospitals were reviewed. The main variables of the present study were the type of prosthesis and the CRP level. More information was recorded in those patients with normal CRP: radiographs, physical examination records and the ESR.Results Seventy-three patients were included in study. Preoperative CRP levels were normal (lower than 0.8 mg/dl) in 23 patients, representing 32% of all PJI with positive cultures. Low virulence micro-organisms, 12 coagulase-negative staphylococci and four P. acnes, grew in most of them. They represented 70% of all PJI with normal CRP levels. In addition, 17 patients (23% of all PJI with positive cultures) had a normal ESR, a normal physical examination (they only presented with pain) and no clear loosening was observed in the radiographs.Conclusions Per the American Association of Orthopaedic Surgeons (AAOS) guidelines or the Musculoskeletal Infection Society (MSIS), 23% of the patients in the present study with PJI would never have been identified. Blood inflammatory markers such as the CRP level and ESR may not be accurate as diagnostic tools in PJI, particularly to identify low-grade and chronic PJI.