C-reactive protein-guided approach may shorten length of antimicrobial treatment of culture-proven late-onset sepsis: an intervention study

Abstract

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of antimicrobial treatment duration of LOS. From January 1996 to December 2002, all consecutive infants aged ≤ ≤ ≤ ≤ ≤28 days admitted to a single medical-surgical ICU and diagnosed with primary LOS were enrolled in a prospective, intervention trial with historical controls. Only blood culture-positive LOSs were included. Exclusion criteria were: age >28 days at diagnosis of LOS, development of site-specific infection, and central venous catheter-related LOS. From January 1996 to July 1998 (historical control group), antimicrobial treatment of LOS was offered for at least 14 days. From August 1998 to December 2002 (intervention group), neonates underwent serial semiquantitative measurements of serum CRP, and antimicrobial treatment was discontinued when CRP was ≤ ≤ ≤ ≤ ≤12 mg/L. Primary efficacy endpoint was the duration of antimicrobial therapy. Secondary efficacy endpoints were the proportion of relapsing sepsis within 72 hours of antibiotic withdrawal and the overall mortality rate. The historical control group comprised 76 neonates developing 85 episodes of LOS; 138 LOS occurring in 120 patients comprised the intervention group. Length of antimicrobial treatment of LOS was significantly shorter during the second study period (16 days vs. 9 days, p<0.001). Secondary efficacy endpoints showed similar rates of relapsing sepsis and overall mortality in both time periods.

Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants

“…CRP is the most commonly used acute-phase reactant in neonates. 23 As CRP increases 12 to 24 h after the onset of infection, it is usually used in combination with other markers. PCT is another marker, which has been used recently in combination with CRP in the diagnosis of neonatal sepsis.…”

Neonatal Procalcitonin Intervention Study (NeoPInS): Effect of Procalcitonin-guided decision making on Duration of antibiotic Therapy in suspected neonatal early-onset Sepsis: A multi-centre randomized superiority and non-inferiority Intervention Study

“…Thus rapid diagnostic test(s) that differentiate infected from non-infected infants, particularly in the early newborn period, have the potential to make a significant impact on neonatal care. In an effort to reduce the use of antimicrobial agents in neonates, clinical studies have been undertaken using the biomarker CRP to safely influence the length of antimicrobial therapy [10,11]. Thus far, no evidence has been presented that using CRP can make an impact on the length of antimicrobial therapy.…”

Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia

“…Before aetiology has been established, or when aetiology cannot be established, an indicator of the appropriateness of empirical antibiotic therapy may contribute to a more tailored approach in antibiotic treatment early in the course of the disease. Furthermore, such an indicator might help in continuing tailored antibiotic therapy, determining the length of antimicrobial treatment, and guiding a switch from intravenous to oral antibiotic therapy [6]. Hypothetically, these strategies may contribute to a reduction in antibiotic consumption.…”