The C-Reactive Protein May Not Detect Infections Caused by Less-Virulent Organisms.

Autor: Deirmengian CA; The Rothman Institute, Thomas Jefferson University, The Lankenau Institute for Medical Research, Wynnewood, Pennsylvania; CD Diagnostics, Claymont, Delaware., Citrano PA; CD Diagnostics, Claymont, Delaware., Gulati S; CD Diagnostics, Claymont, Delaware., Kazarian ER; University of Michigan Medical School, Ann Arbor, Michigan., Stave JW; CD Diagnostics, Claymont, Delaware., Kardos KW; CD Diagnostics, Claymont, Delaware.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2016 Sep; Vol. 31 (9 Suppl), pp. 152-5. Date of Electronic Publication: 2016 Mar 15.
DOI: 10.1016/j.arth.2016.01.060
Abstrakt: Background: The aim of the present study was to evaluate the influence of organism type on the performance of the synovial fluid C-reactive protein (CRP) test.
Methods: We retrospectively reviewed the results of 21,422 synovial fluid samples sent to one common laboratory for the purpose of diagnostic testing for periprosthetic joint infection. Both a synovial fluid CRP result and a positive culture were present for 1789 submitted samples. The cultured organisms were grouped by species, virulence, and gram type; and the median CRP level was determined for each group.
Results: The median synovial fluid CRP level was significantly lower for less-virulent organisms, when compared to those organisms classified as virulent (15.10 mg/L vs 32.70 mg/L; P < .0001). Some less-virulent species such as yeast and Staphylococcus epidermidis were associated with a 4-10 times lower CRP response than those of virulent organisms such as Streptococcus agalactiae and Staphylococcus aureus (P < .0001). Bacterial gram type had no influence on the median CRP result. The rate of false-negative CRP values was 50.9% for yeast, 29.4% for S. epidermidis, 28.5% for all less-virulent organisms, and 11.6% for all virulent organisms.
Conclusion: The CRP response appears to be highly dependent on the infecting organism and is more likely to provide false-negative results in the setting of less-virulent organisms. Although the use of a CRP level is an important part of the workup for periprosthetic joint infection, surgeons must be aware that this protein may yield a false-negative result in the setting of less-virulent organisms.
(Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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