C-Reactive Protein
Strong evidence supports that C-reactive Protein is a strong rule-in and rule-out marker for patients with suspected surgical site infections.
Management of Surgical Site Infections
Endorsed by: POSNA, AANA, APTA, MIS, OTA
Rationale
Multiple high-quality studies and meta-analysis of the study data support the use of C-reactive protein in the diagnosis of surgical site infection (Bottner et al 2007, Glehr et al 2013, Cipriano et al 2012, Jacovides et al 2011). Several moderate quality studies (Yi et al 2015, Piper et al 2009, 2010, Bedair et al 2011) also support its use. It was found to be both sensitive and specific in detecting periprosthetic infection and served as an accurate screening tool, with a positive or negative value demonstrating the likelihood of the presence or absence of infection. Studies vary with respect to the timing and thresholds used to diagnose infection. Both Yi et al 2015 and Bedair et al 2011 confirmed its utility during the early postoperative period. Despite this variation, it has proven its accuracy across investigations. While cutoff values at which an infection is diagnosed vary between studies, and based on time postoperatively it has been shown to be a superior screening test relative to other serological studies.
- Bedair,H., Ting,N., Jacovides,C., Saxena,A., Moric,M., Parvizi,J., Della Valle,C.J. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res 2011/1; 1: 34-40
- Bottner,F., Wegner,A., Winkelmann,W., Becker,K., Erren,M., Gotze,C. Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement. J Bone Joint Surg Br 2007/1; 1: 94-99
- Cipriano,C.A., Brown,N.M., Michael,A.M., Moric,M., Sporer,S.M., Della Valle,C.J. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am 2012/4/4; 7: 594-600
- Glehr,M., Friesenbichler,J., Hofmann,G., Bernhardt,G.A., Zacherl,M., Avian,A., Windhager,R., Leithner,A. Novel biomarkers to detect infection in revision hip and knee arthroplasties. Clin Orthop Relat Res 2013/8; 8: 2621-2628
- Jacovides,C.L., Parvizi,J., Adeli,B., Jung,K.A. Molecular markers for diagnosis of periprosthetic joint infection. J Arthroplasty 2011/9; 6: 99-103
- Piper,K.E., Jacobson,M.J., Cofield,R.H., Sperling,J.W., Sanchez-Sotelo,J., Osmon,D.R., McDowell,A., Patrick,S., Steckelberg,J.M., Mandrekar,J.N., Fernandez,Sampedro M., Patel,R. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. 2009/6; 6: 1878-1884
- Yi,P.H., Cross,M.B., Moric,M., Levine,B.R., Sporer,S.M., Paprosky,W.G., Jacobs,J.J., Della Valle,C.J. Do serologic and synovial tests help diagnose infection in revision hip arthroplasty with metal-on-metal bearings or corrosion?. Clin Orthop Relat Res 2015/2; 2: 498-505