Inflammatory response in confirmed non-diabetic foot and ankle infections:A case series with normal inflammatory markers  

作　　者：Amr Hassan Ahmed Shah Ahmed Ahmed Barakat Jitendra Mangwani Helena White 

机构地区：[1]Department of Trauma and Orthopedics,Leicester University Hospitals-NHS Trust,Leicester LE15WW,Leicestershire,United Kingdom [2]Department of Infectious Diseases and Tropical Medicine,Leicester Royal Infirm,Leicester LE15WW,Leicestershire,United Kingdom

出　　处：《World Journal of Orthopedics》2023年第3期136-145,共10页世界骨科杂志（英文版）

摘　　要：BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy.Multiple reports have focused on the diagnostic accuracy of different inflammatory markers,however,mainly in the diabetic population.AIM To evaluate the diagnostic accuracy of white cell count(WCC)and C-reactive protein(CRP)as diagnostic tools for this distinction in the non-diabetic cohort.METHODS Data was reviewed from a prospectively maintained Infectious Diseases Unit database of 216 patients admitted at Leicester University Hospitals–United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020(68 mo).All patients with confirmed diagnosis of diabetes were excluded while only those with confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study.For the included patients,we retrospectively retrieved the inflammatory markers(WCCs and CRP)at the time of presentation.Values of CRP 0-10 mg/L and WCC 4.0-11.0×109/L were considered normal.RESULTS After exclusion of patients with confirmed diabetes,25 patients with confirmed foot or ankle infections were included.All infections were confirmed microbiolo-gically with positive intra-operative culture results.7(28%)patients with osteomyelitis(OM)of the foot,11(44%)with OM of the ankle,5(20%)with ankle septic arthritis and 2(8%)patients with post-surgical wound infection were identified.Previous bony surgery was identified in 13(52%)patients,either a corrective osteotomy or an open reduction and internal fixation for a foot or ankle fracture with the infection developing on top of the existing metalwork.21(84%)patients did have raised inflammatory markers while 4(16%)patients failed to mount an inflammatory response even with subsequent debridement and removal of metal work.CRP sensitivity was 84%,while WCC sensitivity was only 28%.CONCLUSION CRP has a relatively good sensitivity in the diagnosis of foot and an

关 键 词：OSTEOMYELITIS Septic arthritis Surgical site infection Inflammatory markers C-reactive protein White cell count 

分 类 号：R684.3[医药卫生—骨科学]