# Serial C-reactive Protein as a Sensitive Marker of Treatment Response and Disease Severity in Acute Hand Infections

## TL;DR

This study shows that tracking C-reactive protein levels over time is more useful than white blood cell counts for monitoring treatment in hand infections.

## Contribution

The study demonstrates that serial CRP measurements are more sensitive than WBC for tracking treatment response in acute hand infections.

## Key findings

- CRP levels dropped significantly during treatment, unlike WBC counts.
- Higher initial CRP levels were linked to deeper infections and longer hospital stays.
- Staphylococcus aureus was the most common cause of the infections studied.

## Abstract

Introduction: Acute hand infections are a frequent cause of emergency surgical admission and can lead to significant morbidity. C‑reactive protein (CRP) and white blood cell (WBC) count are commonly used biomarkers, yet their comparative value for monitoring treatment response remains unclear.

Methods: We conducted a retrospective cohort study of 69 consecutive patients with culture‑positive acute hand infections admitted between January and May 2024 at a single tertiary centre. Demographics, comorbidities, infection type, microbiology, management strategy, and outcomes were collected. CRP and WBC were recorded at admission and serially throughout treatment. Trends were analysed in relation to infection type and clinical response.

Results: The cohort was predominantly male, with 51 patients (73.9%), and diabetes mellitus was the most common comorbidity, being present in 22 patients (31.9%). Staphylococcus aureus was the leading pathogen. Elevated CRP (>10 mg/L) was present in 62 patients (89.86%) on admission, while leukocytosis was observed in 16 patients (23.2%). Mean CRP declined significantly from 72.4 mg/L at admission to 18.6 mg/L by discharge (p<0.001), whereas WBC changes were not statistically significant (p=0.184). Deep infections demonstrated significantly higher admission CRP levels than superficial infections (112.3 mg/L vs. 38.7 mg/L; p=0.002).

Conclusions: Serial CRP measurement is a more sensitive marker of treatment response in acute hand infections than WBC. Higher admission CRP correlates with deeper infections and longer hospital stay. Incorporating serial CRP monitoring into routine care may support antibiotic stewardship, discharge planning, and resource utilisation.