C-Reactive Protein Is a Useful Marker for Guiding Duration of Antibiotic Therapy in Suspected Neonatal Bacterial Infection

Ehl, Stephan; Gering, Bettina; Bartmann, Peter; Högel, Josef; Pohlandt, Frank

doi:10.1542/peds.99.2.216

Cited by 160 publications

(125 citation statements)

References 15 publications

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“…Alguns trabalhos também mostraram fatos semelhantes e, por vezes, incluíam essas crianças no grupo daquelas com sepse comprovada 7,21,26 .…”

Section: Discussionunclassified

Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

Caldas¹,

Marba²,

Blotta³

et al. 2008

J Pediatr (Rio J)

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ARTIGO ORIGINALAccuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis Acurácia diagnóstica do leucograma, Resultados: Estudaram-se 82 crianças, sendo 42 no grupo SC, 16 no SP e 24 NI. Nos três momentos, as medianas da PCR e da IL-6 mostraram-se significativamente mais elevadas nos grupos SC e SP, e as do TNF-α alteraram-se apenas no grupo SC. Os índices diagnósticos da PCR foram elevados nos três momentos e com acurácia superior a do leucograma e semelhante a da IL-6 e a do TNF-α em suas primeiras medidas. Entre as citocinas, não houve diferença estatística entre elas, nem em relação ao leucograma. A associação dos testes não aumentou a capacidade diagnóstica, exceto na combinação entre leucograma e PCR2 e na dosagem seriada de PCR. Conclusões:A PCR e o leucograma mostram-se úteis no diagnóstico de sepse neonatal tardia e comparáveis à IL-6 e ao TNF-α. A acurácia aumentou com a associação PCR-leucograma e a dosagem seriada da PCR.J Pediatr (Rio J). 2008;84(6):536-542: Recém-nascido, sepse, proteína C-reativa, interleucina-6, fator de necrose tumoral, citocina, mediadores da inflamação. AbstractObjective: To evaluate the diagnostic value for late neonatal sepsis of white blood cell count (WBC) and assays for C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), in isolation and in conjunction.Methods: This was a diagnostic test validation study. Chemiluminescence was used to assay CRP, IL-6 and TNF-α at the time of clinical suspicion and again after 24 and 48 hours, whereas the WBC was performed only once, at the time of suspicion. Patients were classified into three groups based on clinical progress and culture results: confirmed sepsis (CS), probable sepsis (PS), and not infected (NI). Statistical analysis was performed using the Wilcoxon and chi-square tests and Friedman analysis of variance; cutoffs were defined by plotting receiver operator characteristic curves. Results:The total study sample comprised 82 children, 42 of whom were classed as CS, 16 as PS and 24 as NI. At all three test times, the medians for CRP and IL-6 were significantly more elevated in the CS and PS groups, while the medians for TNF-α were abnormal only in the CS group. The CRP test had elevated indices of diagnostic utility at all three test times, better accuracy than the WBC and similar accuracy to the first IL-6 and TNF-α assays. There was no statistical difference between the cytokines, nor between them and the WBC. Combining tests did not increase diagnostic power, with the exception of the combination of WBC with CRP2 and when the sequential CRP assays were combined. Conclusions:Both CRP and WBC were useful for the diagnosis of late neonatal sepsis and comparable with IL-6 and TNF-α. Accuracy increased when CRP and WBC were combined and when sequential CRP assay results were used.J Pediatr (Rio J). 2008;84(6):536-542: Neonate, sepsis, C-reactive protein, interleukin-6, tumor necrosis factor, cytokine, inflammatory...

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“…Alguns trabalhos também mostraram fatos semelhantes e, por vezes, incluíam essas crianças no grupo daquelas com sepse comprovada 7,21,26 .…”

Section: Discussionunclassified

Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

Caldas¹,

Marba²,

Blotta³

et al. 2008

J Pediatr (Rio J)

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“…2005, that were maintained in the publication of the surviving sepsis campaign of Delinger and cols., 2012) associated with reactive C protein greater than 10 mg/dL (10)(11)(12)(13)(14) were included in the study.…”

Section: Methodsmentioning

confidence: 99%

“…Duration of sepsis was classified as sepsis of short duration (Group A) by the presence of clinical and laboratory signs until the 8 th day of evolution and prolonged sepsis (Group B) when signs were observed beyond the 8 th day of evolution (13). Cure was considered when clinical and laboratory variable of sepsis were absent and reactive protein C was lower than 10 mg/dL (12,14,15).…”

Section: Methodsmentioning

confidence: 99%

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

Silva

Araújo

Diniz

et al. 2015

Arch. Endocrinol. Metab.

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Objective: To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods: We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results: 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions: This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34

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“…18 Yentis SM et al and Ellis S et al showed that measurement of CRP can be used to monitor the antibiotic therapy and that successful antibiotic therapy lowered CRP levels. 19,20 As a summary, this study has thrown up positive results regarding the utility of CRP in burn patients. The CRP values correctly predict sepsis in majority of the patients.…”

Section: Discussionmentioning

confidence: 82%

C-reactive protein: an early predictor of sepsis in patients with thermal burns

2017

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Background: Due to the high mortality rate of established sepsis in patients with burn injuries, it would be beneficial if the onset can be predicted before it is fully established. The objective of the study was to estimate the predictive value of C-reactive protein in thermal burns patients. The secondary objective was to determine how much earlier CRP level allowed the prediction of sepsis in these patients.Methods: This was a case-control study, conducted prospectively on 60 human patients admitted with thermal burns. Cases were those who developed sepsis following burns and the controls were burns patients without sepsis. All patients underwent serial estimation of C-reactive protein values on alternative days, along with other blood parameters. From the data, the predictive value of C-reactive protein in sepsis was analysed.Results: A significant higher value of C-reactive protein was found in septic patients. Rise in serum C-reactive protein level predicted sepsis with an efficacy of 87%, while the sensitivity was found to be 93% and the specificity was 80%, with a significant odds ratio of 56. Also a pre-defined rise in C-reactive protein predicted the onset of sepsis about 2 days before the clinical onset.Conclusions: C-reactive protein is a useful indicator for sepsis in burns patients. In combination with clinical sepsis markers, C-reactive protein can be used to initiate intensive monitoring and appropriate antibiotic therapy.

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C-Reactive Protein Is a Useful Marker for Guiding Duration of Antibiotic Therapy in Suspected Neonatal Bacterial Infection

Abstract: We conclude that CRP could be a key parameter for individually guiding the duration of antibiotic treatment in a major subgroup of newborns with suspected bacterial infection. This approach would allow considerably shorter courses of antibiotic therapy.

Cited by 160 publications

References 15 publications

Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

C-reactive protein: an early predictor of sepsis in patients with thermal burns

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