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In Vivo Mouse Model of Spinal Implant Infection
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C-reactive protein misdiagnoses delayed postoperative spinal implant infections in patients with low-virulent

Doruk Akgün1, Justus Bürger2, Matthias Pumberger3

  • 1Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Chariteplatz 1, 10117, Berlin, Germany.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|February 4, 2019
PubMed
Abstract

Insights

Serum C-reactive protein (CRP) is not a reliable marker for diagnosing delayed postoperative spinal implant infections (PSII). The study found low sensitivity and specificity, even with optimized cutoffs, due to common low-virulent pathogens.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • C-reactive protein (CRP) is a sensitive marker for acute postoperative spinal implant infections (PSII).
  • Limited data exist on CRP's efficacy in diagnosing delayed PSII.
  • Establishing diagnostic cutoff values for delayed PSII using serum CRP is crucial.

Purpose of the Study:

  • To determine optimal cutoff values for serum CRP in diagnosing delayed postoperative spinal implant infections (PSII).
  • To evaluate the diagnostic performance of CRP for delayed PSII.

Main Methods:

  • Retrospective analysis of patients undergoing revision surgery for instrumented spinal fusion (Jan 2013-Jan 2016).
  • Inclusion of demographic data, laboratory values, infection details, comorbidities, and clinical presentation.
  • Diagnosis of PSII based on European Bone and Joint Infection Society criteria.

Main Results:

  • 61 of 257 patients (24%) were diagnosed with PSII.
  • Significantly higher CRP levels in septic vs. aseptic cohorts (19.3 vs. 4.8 mg/l, p < 0.001).
  • 43% of PSII patients had normal CRP (<5 mg/l); ROC analysis yielded a CRP threshold of 4.05 mg/l with 64% sensitivity and 68% specificity.

Conclusions:

  • Serum CRP demonstrates low sensitivity and specificity for diagnosing delayed PSII.
  • Low-virulent pathogens contribute to the reduced diagnostic accuracy of CRP.
  • Optimized CRP cutoffs did not sufficiently improve diagnostic performance for delayed PSII.
Keywords:
CRPDiagnosticInfectionPosterior fusionRevision surgerySpine surgery

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