Infection surveillance in transsphenoidal pituitary surgery - comparison of lipopolysaccharide-binding-protein, interleukin 6, C-reactive protein, white blood cell count, erythrocyte sedimentation rate and body temperature

One of the major concerns in transsphenoidal surgery are infections because the approach to the pituitary includes a route of microbial colonization. To minimize the associated morbidity and mortality, a surveillance program is crucial to monitor for perioperative infections. For 1 year, we analysed body temperature (BT), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), C-reactive protein (CRP), interleukin 6 (IL-6) and lipopolysaccharide-binding-protein (LBP) following elective transsphenoidal pituitary surgery. Samples were collected on admission, day 1, 3 and 7 as well as 3 months postoperatively. In 116 patients, all data were available. No postoperative infections occurred within the first postoperative week. BT (37.6 +/- 0.6, baseline 37.0 +/- 0.5 A degrees C), WBC (11,366 A +/- 2,541, baseline 6,861 A +/- 2,123/mu l), CRP (25.3 A +/- 22.6, baseline 3.1 A +/- 6 mg/l), IL-6 (12 A +/- 13, baseline 2.7 A +/- 2.6 pg/ml), and LBP (11.3 A +/- 4.9, baseline 5.7 A +/- 2.7 mu g/ml) peaked on day 1 postoperatively (each p = 0.001), while ESR peaked on day 3 (25 A +/- 16, baseline 13 A +/- 11 mm/h, p = 0.001). BT and IL-6 normalized by day 3 and CRP by day 7, while ESR (23 A +/- 16 mm/h, p = 0.001), WBC (7,807 A +/- 2,750/mu l, p = 0.001) and LBP (7.3 A +/- 2.6 mu g/ml, p = 0.028) were still increased by day 7. The present study establishes normative values for an infection surveillance following transsphenoidal pituitary surgery. CRP, a convenient and reasonable priced parameter, is affected by the procedure for the first postoperative week. IL-6 is more robust and allows a close monitoring on the expense of additional pricing. ESR, WBC and LBP are sustained affected by surgery, and do not offer any advantage. Since no infections were observed, we were unable to calculate the respective sensitivity and specificity.