Surgical Site Infection Following Spine Surgery: Diagnostic Potential of CRP, ESR, and WBC in Predicting Infection

Abstract

Early surgical site infection (SSI) detection could save costs and prevent morbidity. Our aim is to evaluate whether C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte count (WBC), or high sensitivity CRP (hsCRP) measurements could effectively predict a SSI, and establish a low-cost method for early diagnosis. This prospective study was conducted at Chi-Mei Medical Center from January 2004 to December 2005. Eligible spinal surgery patients received CRP, ESR, WBC, and hsCRP measurements at pre-specified days. SSI was identified using definitions from the Centers for Disease Control and Prevention and the National Nosocomial Infection Surveillance. Eighty-five patients were enrolled. Four patients experienced SSIs (4.71%). CRP and hsCRP levels from day 2 to 14 demonstrated statistically significantly higher in SSI patients (P<0.001). A threshold CRP value of 25.4 mg/L at day 7 resulted in a sensitivity of 100% and specificity of 83.3%. A threshold CRP value of 12.05 mg/L at day 14 resulted in a sensitivity of 100% and specificity of 96.7%. ESR was a predictor of a SSI at day 14 (P<0.00001). CRP and hsCRP measurements are effective in predicting SSI. Comparing CRP values between baseline and day 2 is potentially the most cost-effective method for diagnosing post-spine surgery SSIs.