Systemic Inflammatory Markers and Aspiration Cell Count May Not Differentiate Bacterial From Fungal Prosthetic Infections

Colten D. Bracken, Elie F. Berbari, Arlen D. Hanssen, Tad M. Mabry, Douglas R. Osmon, Rafael J. Sierra

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Fungal periprosthetic joint infections (PJIs) are rare. Fewer than 200 cases have been reported in the literature. The characteristics of systemic inflammatory markers and joint aspirate cell count analysis obtained in patients with fungal PJIs have not been fully assessed. The ability to diagnose involvement of fungal PJI preoperatively may optimize the surgical and medical management of these patients.

Questions/purposes: We determined whether preoperative systemic inflammatory markers and total synovial fluid leukocyte count and neutrophil percentage were different between patients with fungal and bacterial PJI.

Methods: We reviewed the medical records of 44 patients with culture-positive diagnosed fungal PJIs treated at our institution between January 1, 2002, and December 31, 2011, in this study. This represented 1.2% of the total 3822 PJIs treated at our institution during the study period. The mean values for C-reactive protein, erythrocyte sedimentation rate, leukocyte count, and neutrophil percentage of patients with purely fungal PJIs were compared to those of 59 patients with bacterial PJIs treated by one surgeon during the same time period.

Results: The mean erythrocyte sedimentation rate values for fungal and bacterial PJIs were 40 mm/hour (95% CI: 30, 50 mm/hour) and 41 mm/hour (95% CI: 33, 49 mm/hour), respectively (p = 0.61). The mean C-reactive protein values for fungal and bacterial PJIs were 42 mg/L (95% CI: 22, 62 mg/L) and 65 mg/L (95% CI: 43, 88 mg/L), respectively (p = 0.42). The mean total nucleated leukocyte counts for fungal and bacterial PJIs were 11,928 (95% CI: 3906, 19,950) with 81% (95% CI: 75%, 88%) neutrophils and 36,901 (95% CI: 21,822, 51,921) with 73% (95% CI: 65%, 81%) neutrophils, respectively (leukocyte count: p = 0.19; neutrophil percentage: p = 0.55).

Conclusions: Early detection of fungal PJI is needed, but systemic inflammatory markers and synovial fluid cell count analyses from aspirations do not discriminate whether an infection may be of fungal origin.

Level of Evidence: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)3291-3294
Number of pages4
JournalClinical orthopaedics and related research
Issue number11
StatePublished - Oct 2 2014

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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