563. Inflammatory Blood Laboratory Levels as Markers of Prosthetic Joint Infection: A Systematic Review and Meta-analysis
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The preoperative diagnosis of prosthetic joint infection (PJI) in patients with a total hip or knee arthroplasty requires the use of systemic inflammation markers. These markers have unclear accuracy. The objectives of this review is to summarize evidence on the accuracy of commonly used systemic inflammation markers such as erythrocyte sedimentation rate (ESR), C reactive protein ( CRP), Interleukin 6 (IL6) and procalcitonin (PCT) for the diagnosis of PJI.
Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus) from 1950 till 1/31/2009. Eligible studies reported on the accuracy peripheral white blood cell count, blood ESR, plasma CRP, IL6 and PCT vs the intraoperative diagnosis of prosthetic joint infection at the time of revision arthroplasty. Two reviewers working independently extracted study characteristics and data to estimate likelihood ratio (LR) and 95% confidence interval (CI) for each result.
Results: We found 30 eligible studies including 3909 revision THA or TKA. The prevalence of PJI in included studies was 32.5% (1270/3909). The accuracy of IL6 was (n=3 studies; PLR 10.3, CI 7.1-15; NLR 0.033, CI 0.01-0.08), for CRP (n=22 studies; PLR 3.3, CI 2.4-4.5; NLR 0.17, CI 0.1-0.27); for ESR n=23 studies; PLR 2.7, CI 2.1-3.6; NLR 0.34, CI 0.23-0.51) and for WBC (n=14 studies; PLR 2.6, CI 1.8-3.8; NLR 0.72, CI 0.6-0.8).
Conclusion: The diagnostic accuracy for WBC, ESR and CRP was better for TKA than for THA. WBC, ESR tests used in the diagnosis of PJI appear to have low accuracy. CRP and IL6 appear to have a better accuracy for the diagnosis of PJI.
Elie Berbari, MD1, Pat Erwin, MLS2, Tad Mabry, MD2, Hassan Murad, MD2, Douglas Osmon, MD3, Mark Spangehl, MD4, James Steckelberg, MD, FIDSA5, Geoffrey Tsaras, MD2 and  E. F. Berbari, None..
T. Mabry, None..
G. Tsaras, None..
M. Spangehl, None..
P. Erwin, None..
H. Murad, None..
J. Steckelberg, None..
D. R. Osmon, None., (1)Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (2)Mayo Clinic, Rochester, MN, (3)Infectious Diseases/Internal Medicine, Mayo Clinic, Rochester, MN, (4)Mayo Clinic, Scottsdale, AZ, (5)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN


E. Berbari, None

P. Erwin, None

T. Mabry, None

H. Murad, None

D. Osmon, None

M. Spangehl, None

J. Steckelberg, None

G. Tsaras, None