title: Predictive value of fever following arthroplasty in diagnosing an early infection.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, "D. Cotugno" Hospital, AORN "Dei Colli", Naples, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Ascione
authors.affiliation: Department of Orthopaedic Surgery, University "Federico II", Naples, Italy Department of Orthopaedic Surgery, University "Federico II", Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Balato
authors.affiliation: Institute of Hygiene, University of Salerno, Salerno, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Boccia
authors.affiliation: Institute of Hygiene, University of Salerno, Salerno, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Caro
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001178:Arthroplasty / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D000071997:Blood Culture / Q000379:methods; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D042241:Early Diagnosis; D005334:Fever / Q000097:blood / Q000209:etiology*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007958:Leukocyte Count / Q000379:methods; D019637:Orthopedic Procedures / Q000009:adverse effects*; D009985:Orthopedics; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D015850:Interleukin-6; D002116:Calcitonin; D002097:C-Reactive Protein