Prognostic Value of Inflammatory Markers during Treatment of Prosthetic Joint Infections
Methods: We conducted a case-control study of adult patients seen at the University of Kansas Medical Center with PJI between 1/1/2003 and 6/30/2013, treated with a 2-stage exchange. Cases had documented treatment failure defined as (1) one positive culture growing the same original organism; (2) two positive cultures growing a different organism; (3) one positive culture growing a new organism with histopathology showing acute inflammation (>5 WBC/high power field) or (4) gross purulence at re-implantation. Controls were patients who did not meet criteria for treatment failure. Serial ESR and CRP were recorded.
Results: A total of 71 patients were enrolled. The mean age was 60 years; 52% were male. Among our patients, 22.5% were smokers, 28% had diabetes mellitus, 10% were immunosuppressed, and 32% had other co-morbidities (peripheral vascular disease, rheumatoid arthritis, liver disease). The mean time between implant and infection was 1922 days. The indication for implantation was osteoarthritis in 64% and post-traumatic causes in 21%. The most common organism isolated was Staphylococcus aureus (34%), followed by coagulase-negative Staphylococcus (30%). Five out of 71 patients (7%) failed treatment. There was a trend towards higher CRP value among patients who failed treatment (mean CRP 11.35 vs 4.23 mg/dL, p-value 0.056). There was no difference in mean ESR, change in ESR or change in CRP between the 2 groups. No other predictors of treatment failure were identified.
Conclusion: CRP values prior to prosthetic joint reimplantation might predict treatment failure in patients with PJI.
M. Brimacombe, None
A. Eid, None