Liebe Jonas, Soldevila-Boixader Laura, Yιldιz İnci, Furrer Pascal R, Jans Peter, Viehöfer Arnd, Wirth Stephan, Uckay İlker
Foot Surgery, Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
Infectious Disease Service, IDIBELL-Hospital Universitari Bellvitge, Universitat de Barcelona, Feixa Llarga s/n, Hospitalet de Llobregat, 08907 Barcelona, Spain.
J Clin Med. 2025 Jun 11;14(12):4122. doi: 10.3390/jcm14124122.
In orthopedic (diabetic) foot surgery, the serum C-reactive protein (CRP) level is frequently measured not only as a diagnostic tool, but also as a control inflammatory marker in the follow-up of postoperative surgical-site infections (SSIs) : We investigated the predictive value of the post-debridement routine (control) serum CRP level in adult (diabetic) patients with an SSI in the foot. We excluded community-acquired (diabetic foot) infections and focused on the predictive accuracy of routine (control) CRP measurements in terms of ultimate therapeutic failures. The median pre- and postoperative CRP levels were 25 mg/L and 8.8 mg/L, respectively. In group comparisons and multivariate assessment, neither the immediate (relative and absolute) drop in the serum CRP level, nor its values between 5 and 8 weeks and between 11 and 14 weeks predicted the failure risk of 19%. In contrast, in cases of surprisingly elevated CRP levels, this finding leads to unnecessary radiological (median costs approximatively USD 200), clinical, microbiological urinary sample (median costs USD 50), and laboratory (one CRP sample USD 10) exams. These additional exams also likely prolong the duration of hospitalization by one to two days (e.g., whilst awaiting the microbiological results) and often generate unnecessary consultations among internist and/or infectious diseases experts (USD 50). : Routine, postoperative CRP monitoring during the treatment of established orthopedic (diabetic) foot SSIs is unnecessarily costly, and should be avoided in favor of clinical surveillance of the postoperative evolution.
在骨科（糖尿病）足部手术中，血清C反应蛋白（CRP）水平不仅常被用作诊断工具，还作为术后手术部位感染（SSI）随访中的炎症控制指标：我们研究了清创术后常规（对照）血清CRP水平对成年（糖尿病）足部SSI患者的预测价值。我们排除了社区获得性（糖尿病足）感染，重点关注常规（对照）CRP测量对最终治疗失败的预测准确性。术前和术后CRP水平的中位数分别为25mg/L和8.8mg/L。在组间比较和多变量评估中，血清CRP水平的即时（相对和绝对）下降及其在5至8周以及11至14周之间的值均未预测出19%的失败风险。相比之下，在CRP水平意外升高的情况下，这一发现会导致不必要的放射学检查（中位数费用约200美元）、临床检查、微生物学尿液样本检查（中位数费用50美元）以及实验室检查（一次CRP样本10美元）。这些额外的检查还可能使住院时间延长一到两天（例如，等待微生物学结果时），并且常常在内科医生和/或传染病专家之间引发不必要的会诊（50美元）。：在已确诊的骨科（糖尿病）足部SSI治疗过程中，术后常规CRP监测成本过高，应避免采用，而应侧重于对术后病情发展的临床监测。
