title: The value of successive Infecton scans in assessing the presence of chronic bone and joint infection and in predicting its evolution after treatment and after a prolonged follow-up.
abstract: OBJECTIVE
  Our objective was to monitor the evolution of bone and/or joint infections with the aid of successive radiolabelled ciprofloxacin (Infecton) scans during antimicrobial treatment and to compare the results of an Infecton scan at the end of therapy with the respective results of clinical evaluation, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in predicting resolution or recurrence of infection after a long period of posttreatment follow-up.
  
  
  METHODS
  Thirty-three patients with documented bone and/or joint infection were subjected to successive Infecton scans on two or three visits. Infecton scans were evaluated visually and scored accordingly. Clinical evaluation was scored by the referring clinicians. ESR and CRP values were evaluated independently. A minimum of 2-year free-of-infection follow-up after discontinuation of the antibiotic treatment served as a measure of successful antimicrobial therapy and nonrecurrence of infection. Statistics included survival analysis (Cox regression).
  
  
  RESULTS
  During follow-up, five patients in the study presented with recurrence, and three died as a result of an irrelevant cause. The remaining patients were followed up for a median of 108 months (range 97-132 months) without any signs of recurrence of infection. Recurrence of infection was 4.2 times more likely to occur in patients with positive Infecton scans [hazard ratio (HR): 4.2, confidence intervals 95%: 1.39-12.67, P=0.011]. Infecton had the highest sensitivity (83.3%), accuracy (69.69%) and negative predictive value (94.74%), whereas CRP had the highest specificity (76.92%).
  
  
  CONCLUSIONS
  Infecton scintigraphy proved to be more sensitive and accurate and had a higher negative predictive value compared with clinical evaluation, ESR and CRP in predicting infection resolution or recurrence in patients with chronic bone and joint infections.
authors.affiliation: Department of Medical Physics, Medical School, University of Athens, Athens, Greece. j.malamitsi@yahoo.gr
authors.forename: Julia
authors.initials: J
authors.lastname: Malamitsi
authors.forename: Antonios
authors.initials: A
authors.lastname: Papadopoulos
authors.forename: Argyroula
authors.initials: A
authors.lastname: Vezyrgianni
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dalianis
authors.forename: Maria
authors.initials: M
authors.lastname: Boutsikou
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods*; D001799:Blood Sedimentation; D001850:Bone Diseases, Infectious / Q000175:diagnosis* / Q000401:mortality; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D002939:Ciprofloxacin / Q000031:analogs & derivatives; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000401:mortality; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012008:Recurrence; D016019:Survival Analysis; D014055:Tomography, Emission-Computed / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C431804:Technetium Tc 99m ciprofloxacin; D002939:Ciprofloxacin; D002097:C-Reactive Protein