Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study

Abstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this stud...

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Autores principales:	Zhong-Yan Li, Yu-Chih Lin, Chih-Hsiang Chang, Szu-Yuan Chen, Tung-Wu Lu, Sheng-Hsun Lee
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Two-stage exchange arthroplasty Periprosthetic joint infection CRP trends Spacer-related complications Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/5bc5a1b3d5a14b90a79543761fd1d9e5
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spelling	oai:doaj.org-article:5bc5a1b3d5a14b90a79543761fd1d9e52021-12-05T12:18:24ZTrend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study10.1186/s12891-021-04893-31471-2474https://doaj.org/article/5bc5a1b3d5a14b90a79543761fd1d9e52021-12-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04893-3https://doaj.org/toc/1471-2474Abstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this study was to identify the relationships between PJI treatment outcomes and our proposed CRP trend definitions, parameters, and microbiological data. The secondary aim was to investigate CRP trends after the occurrence of spacer-related complications. Methods We conducted a retrospective review of 74 patients treated with a two-stage exchange protocol for PJI in a tertiary referral joint center between 2014 and 2016. Patients with factors that may affect CRP levels (inflammatory arthritis, concomitant infections, liver and kidney diseases, and intensive care admissions) were excluded. CRP trends were categorized into five types and PJI treatment outcome was defined as “success” or “failure” according to the Delphi criteria. Results Treatment was successful in 67 patients and failed in 7 patients. Multivariate logistic regression analysis showed that type 5 CRP, defined as serum CRP fluctuation without normalization after first stage surgery (odds ratio [OR]: 17.4; 95% confidence interval [CI]: 2.3–129.7; p = 0.005), and methicillin-resistant Staphylococcus aureus (MRSA; OR: 14.5; 95% CI: 1.6–131.7; p = 0.018) were associated with treatment failure. Spacer-related complications occurred in 18 patients. Of these, 12 had elevated CRP levels at later follow-up, while six had no elevation in CRP levels. Conclusions We found that MRSA infection and type 5 CRP were associated with PJI treatment failure.Zhong-Yan LiYu-Chih LinChih-Hsiang ChangSzu-Yuan ChenTung-Wu LuSheng-Hsun LeeBMCarticleTwo-stage exchange arthroplastyPeriprosthetic joint infectionCRP trendsSpacer-related complicationsDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Two-stage exchange arthroplasty Periprosthetic joint infection CRP trends Spacer-related complications Diseases of the musculoskeletal system RC925-935
spellingShingle	Two-stage exchange arthroplasty Periprosthetic joint infection CRP trends Spacer-related complications Diseases of the musculoskeletal system RC925-935 Zhong-Yan Li Yu-Chih Lin Chih-Hsiang Chang Szu-Yuan Chen Tung-Wu Lu Sheng-Hsun Lee Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
description	Abstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this study was to identify the relationships between PJI treatment outcomes and our proposed CRP trend definitions, parameters, and microbiological data. The secondary aim was to investigate CRP trends after the occurrence of spacer-related complications. Methods We conducted a retrospective review of 74 patients treated with a two-stage exchange protocol for PJI in a tertiary referral joint center between 2014 and 2016. Patients with factors that may affect CRP levels (inflammatory arthritis, concomitant infections, liver and kidney diseases, and intensive care admissions) were excluded. CRP trends were categorized into five types and PJI treatment outcome was defined as “success” or “failure” according to the Delphi criteria. Results Treatment was successful in 67 patients and failed in 7 patients. Multivariate logistic regression analysis showed that type 5 CRP, defined as serum CRP fluctuation without normalization after first stage surgery (odds ratio [OR]: 17.4; 95% confidence interval [CI]: 2.3–129.7; p = 0.005), and methicillin-resistant Staphylococcus aureus (MRSA; OR: 14.5; 95% CI: 1.6–131.7; p = 0.018) were associated with treatment failure. Spacer-related complications occurred in 18 patients. Of these, 12 had elevated CRP levels at later follow-up, while six had no elevation in CRP levels. Conclusions We found that MRSA infection and type 5 CRP were associated with PJI treatment failure.
format	article
author	Zhong-Yan Li Yu-Chih Lin Chih-Hsiang Chang Szu-Yuan Chen Tung-Wu Lu Sheng-Hsun Lee
author_facet	Zhong-Yan Li Yu-Chih Lin Chih-Hsiang Chang Szu-Yuan Chen Tung-Wu Lu Sheng-Hsun Lee
author_sort	Zhong-Yan Li
title	Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
title_short	Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
title_full	Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
title_fullStr	Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
title_full_unstemmed	Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
title_sort	trend of serum c-reactive protein is associated with treatment outcome of hip periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/5bc5a1b3d5a14b90a79543761fd1d9e5
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Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study

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