Serial C reactive protein values predict sensitivity of organisms to empirical antibiotics in neonates: a nested case–control study

Patil, Sandeep; Dutta, Sourabh; Attri, Savita Verma; Ray, Pallab; Kumar, Praveen

doi:10.1136/archdischild-2015-309158

Cited by 11 publications

(8 citation statements)

References 16 publications

(10 reference statements)

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“…More detailed, serial serum CRP values in the first 48 h of antibiotic therapy help to predict whether the causative organism is sensitive to the empirical antibiotics administered. The suitability of the empirically oriented antibiotic policy could be predicted by a decline in serum CRP within the first 48 h of treatment, which has a high sensitivity and specificity (89% and 80%, respectively) [21]. In addition, the monitoring of serum CRP has an important clinical significance in predicting the prognosis of newborns with sepsis [22,23], which has also been illustrated in our study.…”

Section: Discussionsupporting

confidence: 59%

Evaluation of a turbidimetric C-reactive protein assay to monitor early-onset neonatal sepsis in South Kivu (Democratic Republic of the Congo)

Mulinganya

Balolebwami

Zigabe

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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ObjectivesNeonatal sepsis, a condition defined as bacteremia within the first month of life accompanied by signs of systemic infection, is the most preventable cause of infant mortality in sub-Saharan Africa. Despite the development of new infection markers, C-reactive protein (CRP) is the most extensively studied acute phase reactant so far and the preferred index in many neonatal intensive care units (NICUs). The aim of the present study was to evaluate an affordable, non-commercial turbidimetric CRP assay for monitoring early-onset neonatal sepsis (EOS).MethodsA total of 148 neonates admitted at the NICU of the Hôpital Provincial Général de Référence de Bukavu to diagnose and to monitor EOS were enrolled in the study. CRP was assayed using a functional turbidimetric assay based on the interaction of CRP with phosphocholine containing particles (Intralipid®).ResultsIn total, 62/148 (41.9%) cases were identified as blood culture-proven EOS. Different serum CRP slopes were observed among the different birth weight categories. Moreover, the serum (CRP 48 h–CRP 12 h) difference and the birth weight predicted the outcome of these septic newborns.ConclusionsOur turbidimetric CRP assay is a potential novel tool that can be used in the management of EOS in sub-Saharan Africa. The simplicity of the assay and the extremely low price make the CRP method very well suited for developing countries.

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Section: Discussionsupporting

confidence: 59%

Evaluation of a turbidimetric C-reactive protein assay to monitor early-onset neonatal sepsis in South Kivu (Democratic Republic of the Congo)

Mulinganya

Balolebwami

Zigabe

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…In our cohort none of the infants with sepsis has leukocytosis, and there was no difference between infants with sepsis and normal newborns regarding leukopenia (3% vs. 1.4%, P value = 0.492). Using CRP is not very helpful at the onset of illness [24]. Serial CRP readings have more value [13] which helps in the follow-up of infants at risk who did not receive empirical antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Rupture of Membranes, Neonatal Outcomes and Management Guidelines

et al. 2019

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Background Prolonged rupture of membranes (PROM) is a risk factor for early-onset neonatal sepsis (EOS). In the absence of early specific and sensitive diagnostic tools, management of asymptomatic infants is difficult. This study was conducted to investigate clinical outcomes of newborns born to mothers with PROM. Methods A retrospective study of neonates ≥ 34 weeks admitted due to PROM was conducted. Medical charts were reviewed. Neonates were classified into three categories based on their status at birth: ill appearing, well, and equivocal. Sepsis risk calculator was retrospectively applied. Results A total of 176 neonates were included. All mothers had unknown group B streptococcus (GBS) status. Of them, 74.4% were asymptomatic. Nine infants (5%) had positive cultures, and 23 infants (13%) had culture-negative sepsis. The newborns with sepsis fit into the “ill appearing” category with a significantly higher proportion (12.5% vs. 0.0%, P value < 0.0). Conclusions Reliable early diagnostic tools for neonatal sepsis are lacking. Adopting a protocol that utilizes multiple methods and follow-up for the clinical condition of these infants are the key factors to avoid missing neonates with true sepsis and decreasing the use of antibiotics in those without infection.

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“…Interestingly, a recent study has also demonstrated that serial CRP measurements can predict whether an organism is sensitive to the empirical antimicrobial therapy in the first 48 h of treatment of neonatal sepsis. 38 These findings now need prospective evaluation.…”

Section: Discussionmentioning

confidence: 99%

Population pharmacokinetics and pharmacodynamics of teicoplanin in neonates: making better use of C-reactive protein to deliver individualized therapy

Ramos-Martín

Neely

McGowan

et al. 2016

J. Antimicrob. Chemother.

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Objectives: There is uncertainty about the optimal teicoplanin regimens for neonates. The study aim was to determine the population pharmacokinetics (PK) of teicoplanin in neonates, evaluate currently recommended regimens and explore the exposure-effect relationships.Methods: An open-label PK study was conducted. Neonates from 26 to 44 weeks post-menstrual age were recruited (n ¼ 18). The teicoplanin regimen was a 16 mg/kg loading dose, followed by 8 mg/kg once daily. Therapeutic drug monitoring and dose adjustment were not conducted. A standard two-compartment PK model was developed, followed by models that incorporated weight. A PK/pharmacodynamic (PD) model with C-reactive protein serial measurements as the PD input was fitted to the data. Monte Carlo simulations (n¼ 5000) were performed using Pmetrics. The AUCs at steady state and the proportion of patients achieving the recommended drug exposures (i.e. C min .15 mg/L) were determined. The study was registered in the European Clinical Trials Database Registry (EudraCT: 2012-005738-12).Results: The PK allometric model best accounted for the observed data. The PK parameters medians were:). The individual time-course of C-reactive protein was well described using the Bayesian posterior estimates for each patient. The simulated median AUC 96-120 was 302.3 mg . h/L and the median C min at 120 h was 12.9 mg/L; 38.8% of patients attained a C min .15 mg/L by 120 h.Conclusions: Teicoplanin population PK is highly variable in neonates, weight being the best descriptor of PK variability. A low percentage of neonates were able to achieve C min .15 mg/L. The routine use of therapeutic drug monitoring and improved knowledge on the PD of teicoplanin is required.

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Serial C reactive protein values predict sensitivity of organisms to empirical antibiotics in neonates: a nested case–control study

Abstract: Serial CRP values in the first 48 h of antibiotic therapy help to predict whether the causative organism is sensitive to the empirical antibiotics administered.

Cited by 11 publications

References 16 publications

Evaluation of a turbidimetric C-reactive protein assay to monitor early-onset neonatal sepsis in South Kivu (Democratic Republic of the Congo)

Evaluation of a turbidimetric C-reactive protein assay to monitor early-onset neonatal sepsis in South Kivu (Democratic Republic of the Congo)

Prolonged Rupture of Membranes, Neonatal Outcomes and Management Guidelines

Population pharmacokinetics and pharmacodynamics of teicoplanin in neonates: making better use of C-reactive protein to deliver individualized therapy

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