Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery

Khan, Mustafa; Smith, Patrick N.; Rao, Nalini; Donaldson, William F.

doi:10.1016/j.spinee.2005.07.006

Cited by 100 publications

(62 citation statements)

References 12 publications

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“…However, the elevated level was sustained in the infected group for a longer period. The CRP level is one of the most valuable markers for evaluating infectious processes in the clinical field (10,15,40). In this study, there was a high correlation between the CRP level and bacterial PI in vivo during the chronic phase, suggesting that our model is useful for real-time, noninvasive monitoring of the chronic inflammatory processes in osteomyelitis.…”

Section: Discussionmentioning

confidence: 65%

Establishment of a Real-Time, Quantitative, and Reproducible Mouse Model of Staphylococcus Osteomyelitis Using Bioluminescence Imaging

et al. 2012

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Osteomyelitis remains a serious problem in the orthopedic field. There are only a few animal models in which the quantity and distribution of bacteria can be reproducibly traced. Here, we established a real-time quantitative mouse model of osteomyelitis using bioluminescence imaging (BLI) without sacrificing the animals. A bioluminescent strain of Staphylococcus aureus was inoculated into the femurs of mice. The bacterial photon intensity (PI) was then sequentially measured by BLI. Serological and histological analyses of the mice were performed. The mean PI peaked at 3 days, and stable signals were maintained for over 3 months after inoculation. The serum levels of interleukin-6, interleukin-1␤, and C-reactive protein were significantly higher in the infected mice than in the control mice on day 7. The serum monocyte chemotactic protein 1 level was also significantly higher in the infected group at 12 h than in the control group. A significantly higher proportion of granulocytes was detected in the peripheral blood of the infected group after day 7. Additionally, both acute and chronic histological manifestations were observed in the infected group. This model is useful for elucidating the pathophysiology of both acute and chronic osteomyelitis and to assess the effects of novel antibiotics or antibacterial implants.

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Section: Discussionmentioning

confidence: 65%

Establishment of a Real-Time, Quantitative, and Reproducible Mouse Model of Staphylococcus Osteomyelitis Using Bioluminescence Imaging

et al. 2012

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“…In adults, few authors have investigated serum CRP levels with the clinical response of surgical site infections after spinal surgery. Although the CRP levels of patients at the fourweek-antibiotic treatment time point were lower than in patients that healed well (mean CRP 0.3±0.5 mg/l) as opposed to those with overt persistent infection (continuing drainage, erythema; mean CRP 7.3±3.5 mg/L), CRP values returned to normal within a few days [23]. In our study, CRP values tended to decrease more rapidly during antibiotic treatment in patients without recurrent infections than in patients with recurrent PJI.…”

Section: Discussionmentioning

confidence: 75%

Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection

Schindler

Christofilopoulos

Wyssa

et al. 2010

International Orthopaedics (SICOT)

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During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intraoperative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218 days after re-implantation, but only four pre-or intraoperative invasive joint samples had grown a pathogen in cultures. In at least seven recurrent PJIs (58%), patients had a normal C-reactive protein (CRP, <10 mg/l) level before re-implantation. The sensitivity, specificity, positive predictive and negative predictive values of pre-operative invasive joint aspiration and CRP for the prediction of PJI recurrence was 0. 58, 0.88, 0.5, 0.84 and 0.17, 0.81, 0.13, 0.86, respectively. As a conclusion, pre-operative joint aspiration, intraoperative bacterial sampling, surgical exploration and serum inflammatory markers are poor predictors of PJI recurrence. The onset of reinfection usually occurs far later than reimplantation.

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“…Sensitive parameters such as the ESR and CRP are not specific. Often they are depressed by antibiotic therapy [4,14]. Furthermore, sensitivity and specificity are influenced and reduced by several factors, including accompanying illnesses.…”

Section: Resultsmentioning

confidence: 99%

Validity of Frozen Sections for Analysis of Periprosthetic Loosening Membranes

Tohtz

Müller

Morawietz

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Clinical findings and blood parameters often are inconclusive in patients with periprosthetic joint infections. Among the accepted criteria for diagnosis, histologic analysis of debrided tissue can detect infection in most cases but does not allow intraoperative decision making. We evaluated the validity of intraoperative frozen sections for detection of prosthetic infections. The results from frozen and permanent sections of periprosthetic membranes of 64 consecutive patients who underwent exchange procedures after hip arthroplasty were compared using the histopathologic consensus classification of Morawietz et al. Blood parameters (erythrocyte sedimentation rate, leukocyte count, C-reactive protein) and culture results of preoperatively aspirated joint fluid and intraoperative tissue samples were correlated with the histologic results. In 50 patients (78.1%), agreement was found between the frozen and permanent sections. Two patients (3.1%) revealed a discrepancy between the two histologic methods. In 12 patients (18.8%), a diagnosis was not possible based on the frozen sections because the tissue samples were not representative enough for definite classification. For the analyzable cases (n = 52), the sensitivity of frozen-section histologic analysis was 86.6%, specificity 100%, and accuracy 96.2%. Our data support a recommendation for use of intraoperative frozen sections for diagnosis of septic versus aseptic loosening in revision hip surgery.

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Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery

Cited by 100 publications

References 12 publications

Establishment of a Real-Time, Quantitative, and Reproducible Mouse Model of Staphylococcus Osteomyelitis Using Bioluminescence Imaging

Establishment of a Real-Time, Quantitative, and Reproducible Mouse Model of Staphylococcus Osteomyelitis Using Bioluminescence Imaging

Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection

Validity of Frozen Sections for Analysis of Periprosthetic Loosening Membranes

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