692Prognostic Value of Inflammatory Markers during Treatment of Prosthetic Joint Infections

Background. The role of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in predicting outcome of prosthetic joint infections (PJI), treated with a 2-stage exchange, has been inconclusive. We evaluated the utility of ESR and CRP and their improvement during treatment in predicting cure at the time of the second stage surgery in adults with PJI treated with a 2-stage approach. Methods. We conducted a case-control study of adult patients seen at the University of Kansas Medical Center with PJI between January 1, 2003 and June 30, 2013, treated with a 2-stage exchange. Cases had documented treatment failure defined as (1) one positive culture growing the same original organism; (2) two positive cultures growing a different organism; (3) one positive culture growing a new organism with histopathology showing acute inflammation (>5 WBC/high power field) or (4) gross purulence at re-implantation. Controls were patients who did not meet criteria for treatment failure. Serial ESR and CRP were recorded. Results. A total of 71 patients were enrolled. The mean age was 60 years; 52% were male. Among our patients, 22.5% were smokers, 28% had diabetes mellitus, 10% were immunosuppressed, and 32% had other co-morbidities (peripheral vascular disease, rheumatoid arthritis, liver disease). The mean time between implant and infection was 1922 days. The indication for implantation was osteoarthritis in 64% and post-traumatic causes in 21%. The most common organism isolated was Staphylococcus aureus (34%), followed by coagulase-negative Staphylococcus (30%). Five out of 71 patients (7%) failed treatment. There was a trend towards higher CRP value among patients who failed treatment (mean CRP 11.35 vs 4.23 mg/dL, p-value 0.056). There was no difference in mean ESR, change in ESR or change in CRP between the 2 groups. No other predictors of treatment failure were identified. Conclusion. CRP values prior to prosthetic joint reimplantation might predict treatment failure in patients with PJI. Disclosures. All authors: No reported disclosures.