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

Autor: Carl Deirmengian, Patrick A. Citrano, Keith Kardos, Simmi Gulati, Erick R. Kazarian, James W. Stave
Rok vydání: 2016
Předmět:
Zdroj: The Journal of Arthroplasty. 31:152-155
ISSN: 0883-5403
DOI: 10.1016/j.arth.2016.01.060
Popis: BackgroundThe 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.MethodsWe 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.ResultsThe 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.ConclusionThe 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.
Databáze: OpenAIRE
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