Use of Erythrocyte Sedimentation Rate and C-Reactive Protein to Predict Osteomyelitis Recurrence

Abstract

Purpose. To determine the association between both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and osteomyelitis recurrence. Methods. Records of 81 males and 27 females aged 10 to 87 (median, 54) years who underwent antibiotic/ surgical treatment for primary (n=68) or recurrent (n=40) osteomyelitis that was related (n=26) or unrelated (n=82) to a prosthesis were reviewed. Of the 40 cases of osteomyelitis recurrence followed up for a median of 23.4 (range, 0.6-74.0) months, 7 and 33 were related and unrelated to a prosthesis, respectively. The cutoff points of lowest ESR and CRP for osteomyelitis recurrence were calculated. Risk factors for osteomyelitis recurrence were determined. Results. Osteomyelitis recurrence was associated with diabetes mellitus, ischaemic heart disease, nonhealing wound, infection in the lower limb, and infection with methicillin-resistant Staphylococcus Use of erythrocyte sedimentation rate and C-reactive protein to predict osteomyelitis recurrence 2016;24(1):77-83 aureus. The cutoff points of CRP ≥5 mg/l and ESR ≥20 mm/h were used for osteomyelitis recurrence. Risk factors for osteomyelitis recurrence were ESR ≥20 mm/h, infection with methicillin-resistant S aureus, and infection in the lower limb. Conclusion. ESR was more sensitive, specific, and independently associated with osteomyelitis recurrence and should be used to guide the duration of antibiotic treatment.

Factors predictive of relapse in adult bacterial osteomyelitis of long bones.

“…Classical laboratory parameters, such as ESR and C-RP, were not valid to discriminate between those patients with or without infection relapse when determined at baseline in our series However, the value of their sequential determination during follow-up has been described in children with acute hematogenous osteomyelitis and also in adults [ 13 , 14 , 33 , 34 ].…”

“…To our knowledge, only few clinical series focusing on the risk factors and outcome of bacterial osteomyelitis have been reported so far, one is a pediatric series of 83 children [ 13 ] while four other series included over 100 adult osteomyelitis patients each [ 8 , 9 , 11 , 14 ] (Table 3 ). Ours is the second work in which a score made of the addition of clinical elements or points to predict osteomyelitis outcome is used and the only one in which this score is applied to adults, focuses exclusively on long bone osteomyelitis of different pathogenesis, analyzes relapses or is derived from the outcome.…”

The infected diabetic foot: Can serum biomarkers predict osteomyelitis after hospital discharge for diabetic foot infections?

“…Monitoring biomarkers could be used to increase the index of suspicion for the treating physician to obtain advanced imaging or perform a percutaneous bone biopsy. There are several small studies of biomarkers to diagnose OM, 15 but there are only a few studies that use biomarkers to monitor the response to treatment of infected orthopedic implants, 16 vertebral infections, 17,18 long bone OM, 19 and diabetic foot OM 6,10,20 . Michail and colleagues evaluated CRP, ESR, white blood cells (WBC), and PCT in 61 patients with DFIs at baseline, after 1 week, 3 weeks, and 3 months of treatment.…”

Promoting appropriate utilisation of laboratory tests for inflammation at an academic medical centre

“…Lastly, the clinical impact of the reduction in ESR tests were not assessed. Although ESR is of low value in assessing acute inflammation in undiagnosed conditions, it may have clinical utility in the management of some specific clinical conditions, such as osteomyelitis, multiple myeloma and macroglobulinaemia 6–8. While there is a small potential risk that this initiative will reduce appropriate ordering of ESR tests, there is likely a greater clinical risk to patients from inappropriate ESR testing, such as false positive tests leading to unnecessary downstream testing or treatment and false negative tests leading to missed diagnostic or therapeutic opportunities.…”