gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

The value of C-reactive protein in serum and CSF in shunt infection management

Die Wertigkeit des C-reaktiven Proteins in Serum und Liquor cerebrospinalis im Management von Shunt-Infektionen

Meeting Abstract

  • corresponding author Martin U. Schuhmann - Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig
  • K. Ostrowski - Children's Hospital of Michigan, Detroit /USA
  • J.-W. Chu - Detroit Medical Center, Detroit /USA
  • J. P. McAllister - Children's Hospital of Michigan, Detroit /USA
  • S. D. Ham - Children's Hospital of Michigan, Detroit /USA
  • S. Sood - Children's Hospital of Michigan, Detroit /USA

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 13.137

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0421.shtml

Veröffentlicht: 23. April 2004

© 2004 Schuhmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

To evaluate the sensitivity and specificity of C-reactive protein in serum \'7bS-CRP\'7d and CSF \'7bC-CRP\'7d for shunt infection management in comparison to data from history and clinical findings and results of CSF investigations.

Methods

In a prospective study 84 patients with suspected shunt infection were evaluated initially and also during the course of treatment if they were found to harbour an infection. CSF results were compared in addition to data from 38 controls, evaluated for shunt dysfunction. A supersensitive CRP assay with a detection limit of 0.05 mg/L was used (usual detection limit in clinical routine 5-9 mg/L).

Results

Thirty-five of 84 patients had an infection. One of these 35 was considered to have been contaminated/infected by the diagnostic shunt tap itself. Excluding this patient, sensitivity of S-CRP was 100% using a threshold of 7 mg/l. Specificity was 73.5%. If patients with other obvious causes for infection like sinusitis, UTI or pneumonia were excluded, specificity rose to 92.3%. C-CRP, white blood cell count and all traditional CSF parameters like glucose, protein, cell counts and gram stain as well as all information from history and clinical findings had no diagnostic significance. Three of 5 patients with elevated CRP on the day of implantation of the new shunt system presented with a recurrent shunt infection, despite negative CSF cultures, low CSF cell counts and normal white blood cell count.

Conclusions

S-CRP was the only parameter with sufficient diagnostic significance. Results suggest that patients with suspected shunt infection should only receive a shunt tap if S-CRP is above 7 mg/L and other obvious causes for infection are excluded. In very early stages of infection, S-CRP is known to increase with a certain delay. Therefore determination should be repeated after 24-48 hours if initial S-CRP was < 7mg/L and symptoms persist. We recommend the implantation of a new shunt system following infection only if S-CRP has decreased below 7 mg/L.