Detection of beginning infection in the early postoperative period is important for the adequate treatment ? There are controversies about the issue which are the reliable markers for early detection of infection.
I don't believe that a systemic immune reaction such as lymphopenia can provide highly sensitive and specific results when diagnosis of PJI is concerned. This gets even worse when patients receive antibiotics before diagnostic work ups are performed. New biomarkers such as alpha-defensin have provided promising results for diagnosis of PJI. It is capable of detecting infection in very early stages.
Thank you, Dr. Shahi. I agree entirely with your opinion. On the other hand, I think the availability and costs of alpha-defensin test is a current concern.
Dear Dr. Tanchev,
Insurance companies have started to reimburse for alpha-defensin test, nevertheless, i agree that its availability is a major concern. I beleive that furute research should focus on expoloring cheap and reproducable biomarkers that can be easliy performed in any center.
Increasing CRP together with high pain, swelling and rubor should give the sure indication for a joint puncture for an antibiogram. Even if with a costly positive defensin-test you need to verify the infection and its germs, before using maybe the wrong antibiotic.
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