Ascione Tiziana, Balato Giovanni, Boccia Giovanni, De Caro Francesco
Department of Infectious Diseases, "D. Cotugno" Hospital, AORN "Dei Colli", Naples, Italy.
Department of Orthopaedic Surgery, University "Federico II", Naples, Italy Department of Orthopaedic Surgery, University "Federico II", Naples, Italy.
Infez Med. 2017 Mar 1;25(1):3-7.
Postoperative fever after orthopaedic surgery is a controversial clinical problem in daily practice because damaged tissue due to surgical intervention can induce the production of proinflammatory cytokines responsible of the systemic inflammatory response syndrome. No current diagnostic marker can differentiate with sufficient accuracy infectious from non-infectious fever in patients undergoing orthopaedic surgery, but early diagnosis of postoperative orthopaedic infections is important in order to rapidly initiate adequate antimicrobial therapy. Review of clinical trials on fever did not establish the parameters reporting sufficient diagnostic accuracy. Blood cultures, white blood-cent count, erythrocyte sedimentation rate and C-reactive protein have low specificity. Procalcitonin and IL-6 can be helpful diagnostic markers supporting clinical findings. An algorithm for evaluation of fever in orthopaedic surgery may be a helpful tool.
骨科手术后的发热在日常临床实践中是一个存在争议的问题，因为手术干预造成的组织损伤可诱导促炎细胞因子的产生，而这些细胞因子会引发全身炎症反应综合征。目前尚无诊断标志物能够足够准确地区分接受骨科手术患者的感染性发热与非感染性发热，但骨科术后感染的早期诊断对于迅速启动适当的抗菌治疗至关重要。对有关发热的临床试验进行回顾后，并未确定具有足够诊断准确性的参数。血培养、白细胞计数、红细胞沉降率和C反应蛋白的特异性较低。降钙素原和白细胞介素-6可能是有助于支持临床发现的诊断标志物。一种评估骨科手术发热的算法可能是一个有用的工具。
