Usefulness of inflammatory markers and clinical manifestation for an earlier method to diagnosis surgical site infection
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ORIGINAL PAPER
Usefulness of inflammatory markers and clinical manifestation for an earlier method to diagnosis surgical site infection after spinal surgery Shuai Zheng 1 & Zheng Wang 2 & Shuai Qin 3 & Jian-Ting Chen 1 Received: 27 September 2019 / Accepted: 2 April 2020 # SICOT aisbl 2020
Abstract Purpose To put forward a method for earlier diagnosis of surgical site infection (SSI) after spinal surgery and identify the best cut-offs of the selective signs. Methods Ninety cases were prospectively collected in consecutive patients who underwent spinal surgery. The patients were divided into the SSI group and the normal group. White blood cell (WBC) count, lymphocyte count, serum amyloid A (SAA), procalcitonin (PCT) and C-reactive protein (CRP) were collected pre-operatively and at three andsix days post-operatively. Erythrocyte sedimentation rates (ESR) were acquired pre-operatively and at six days post-operatively. Body temperature (BT) was measured every day during hospitalisation. The conditions of the surgical sites were recorded at three and six days post-operatively. Differences of BT, the conditions of the wound and the values of the inflammatory markers between the two groups were studied. Finally, we used the receiver operating characteristic curve (ROC curve) to determine the best cut-offs of the selected signs. Results Of the 90 patients, SSI occurred in seven and five of them reached a definite diagnosis of SSI as their bacterial cultures were positive. Significant differences were found in CRP levels at three and six days post-operatively with a cut-off of > 59.4 mg/L and > 34.9 mg/L, respectively; ESR level at six days post-operatively with a cut-off of > 51.5 mm/h; PCT at three days post-operatively with a cut-off of > 0.11 ng/mL; and BT at three days post-operatively with a cut-off of > 37 °C. Also, examination of the wound is also an important sign of SSI. Conclusion CRP, ESR and PCT are considered useful markers for earlier diagnosis of SSI. Combining the above markers with BT and the wound condition yields more accurate results. Keywords Surgical site infection . Inflammatory marker . Clinical manifestation . Earlier diagnosis . Post-operative infection Shuai Zheng and Zheng Wang contributed equally to this work. * Jian-Ting Chen [email protected] Shuai Zheng [email protected] Zheng Wang [email protected] Shuai Qin [email protected] 1
Division of Spine Surgery, Department of Orthopadics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, People’s Republic of China
2
Department of Orthopaedic Trauma & Joint Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, People’s Republic of China
3
Department of Ophthalmology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People’s Hospital,, Zhuhai, Guangdong, People’s Republic of China
Introduction The development of spinal instrumentation and its ability to provide strong fixation has brought great advantages to spinal surgery, such as stabilising the spine, reducing th
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