Serial Serum C-Reactive Protein Levels in the Diagnosis of Neonatal Infection

Benitz, William Ε.; Han, Michael Y.; Madan, Ashima; Ramachandra, Pramela

doi:10.1542/peds.102.4.e41

Cited by 376 publications

(291 citation statements)

References 51 publications

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“…8,9 Standard laboratory findings used to evaluate sepsis in neonates such as leukocytosis, leukopenia, absolute band counts, absolute neutrophil counts, immature to total neutrophil (IT) ratio, and elevated CRP level have limited positive predictive values. 4,10,11 Despite the limited value of hematologic parameters to diagnose true sepsis, the most recent COFN statement recommends extending antimicrobial therapy in asymptomatic neonates exposed to CAM if laboratory parameters are abnormal, even with sterile blood culture findings and particularly if intrapartum antibiotics were administered. 8,9 At our institution, similar guidelines of treating such neonates with prolonged antibiotics were routinely practiced before the current COFN recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…Both the IT ratio and CRP have a high negative predictive value for neonatal infections. 4,10,11,15,16 Therefore, if either the IT ratio or CRP is normal at 6 to 12 hours of life, the likelihood of having an infection is very low. In our cohort, 14.9% of infants had an abnormal IT ratio and 22% of infants had an abnormal CRP finding at 12 hours of age.…”

Section: Figurementioning

confidence: 99%

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Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

et al. 2014

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BACKGROUND AND OBJECTIVE: Chorioamnionitis (CAM) is a major risk factor for neonatal sepsis. At our institution, neonates exposed to CAM and intrapartum antibiotics are treated with prolonged antimicrobial therapy if laboratory values are abnormal despite a sterile blood culture. Recently, the Committee on the Fetus and Newborn (COFN) recommended a similar strategy for treating neonates exposed to CAM. Our objective was to determine the frequency of abnormal laboratory parameters in term and late-preterm neonates exposed to CAM and evaluate the implication of recent COFN guidelines. METHODS: This retrospective data analysis included late-preterm and term neonates exposed to CAM. Laboratory parameters, clinical symptoms and the number of infants treated with prolonged antibiotics were determined. RESULTS: A total of 554 infants met the inclusion criteria. Eighty-three infants (14.9%) had an abnormal immature to total neutrophil ratio (>0.2) and 121 infants (22%) had an abnormal C-reactive protein level (>1 mg/dL) at 12 hours of age. A total of 153 infants (27.6%) had an abnormal immature to total neutrophil ratio and/or abnormal C-reactive protein level at 12 hours of age. Only 4 (0.7%) of 554 infants had a positive blood culture result. A total of 134 (24.2%) infants were treated with prolonged antibiotics (112 [20.2%] were treated solely based on abnormal laboratory data). Lumbar puncture was performed in 120 (21.6%) infants. CONCLUSIONS: When managed by using a strategy similar to recent COFN guidelines, a large number of term and late-preterm infants exposed to CAM who had sterile blood culture findings were treated with prolonged antibiotic therapy due to abnormal laboratory findings. They were also subjected to additional invasive procedures and had a longer duration of hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

et al. 2014

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“…Serial CRP levels are useful to test the probability of suspected infection. However, a normal CRP (28) and IL-8 concentration at the time of clinical suspicion cannot guide the decision whether to treat, especially if symptoms have a short history. The result could be a constellation whereby EOBI cannot be detected by plasma IL-8 any more because it already has declined but CRP levels have not yet increased.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of IL-8-Concentrations in Plasma and Lysed EDTA-Blood in Healthy Neonates and Those with Suspected Early Onset Bacterial Infection

et al. 2004

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Plasma IL-8 is a diagnostic parameter of early-onset bacterial infection (EOBI) in neonates but has a short half-life. The detergent-lysed whole-blood (DLWB) IL-8 consists of both extracellular and cell-bound IL-8. The objective of this study was to investigate kinetics of plasma and DLWB IL-8 in healthy newborns and those with suspected EOBI and to test the hypothesis that determination of DLWB IL-8 results in higher sensitivity for EOBI detection. Sixty-one neonates with clinical and serologic signs of EOBI composed the study group; 188 neonates with risk factors but without EOBI served as control subjects. IL-8 concentrations were determined in plasma and DLWB. In the control group, DLWB IL-8 concentrations were 280-fold higher (9599 pg/mL; SD 4433) up to 24 h post partum than corresponding plasma levels (34.2 pg/mL; SD 18.1). The sensitivity of DLWB versus plasma IL-8 for EOBI was 0.97 versus 0.71 after 6 h and 0.70 versus 0.32 after 24 h. Corresponding values for specificity were 0.95 versus 0.90 after 6 h and 0.92 versus 0.99 after 24 h. After 24 h, the negative predictive value for DLWB versus plasma IL-8 was 0.80 versus 0.66. DLWB IL-8 showed a higher sensitivity for EOBI within 6 h after first clinical suspicion than plasma IL-8. It also remained elevated longer. Our results suggest that DLWB IL-8 results in a higher sensitivity for EOBI. Abbreviations CRP, C-reactive protein DLWB, detergent-lysed whole blood EOBI, early-onset bacterial infection I/T ratio, immature to total neutrophil ratio NPV, negative predictive value PPV, positive predictive value ROC, receiver operator characteristics Neonates are susceptible to infections (1). The differential diagnosis of early-onset bacterial infection (EOBI) therefore must always be present for the neonatologist, regardless of how minor, unexpected, or discrete the clinical symptoms. EOBI is usually defined as occurring up to 72 h after birth (2) and is associated with a high morbidity and mortality risk (1). The nonspecific clinical signs as well as the currently established biochemical and hematologic parameters have their diagnostic limitations (3,4) [reviewed in (5,6)].Plasma IL-8 is an appreciated, highly predictive, and easily accessible chemokine to detect EOBI (7). IL-8 secretion is not limited to infections (8 -10), yet it occurs within 1-3 h of endotoxin challenge (11). As with most cytokines, its plasma half-life is short (Ͻ4 h) (12,13). Circulating IL-8, which can be detected in plasma or serum via immunoassay, is immediately bound to two distinct high-affinity IL-8 receptors that are abundantly present on neutrophils before internalization and degradation (14,15). Therefore, plasma IL-8 reflects only a small portion of the total IL-8 blood pool, because the majority is cell associated (16 -18).Cell association is enhanced by chemokine binding, non-IL-8 -specific receptors. These have been identified on various cell types (19), including the Duffy antigen-related chemokine receptors (16), presented on erythrocytes. Duffy antigenrelated chemokine-li...

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“…Data indicating a pathogen include an elevated serum CRP, 20,21 optimally obtained at least 12 hours after the onset of symptoms, [21][22][23] and a quantitative blood culture with Ͼ50 colony-forming units/mL (or a short incubation time to positive, eg, Ͻ15 hours, using an automated continuously monitored blood culture system). 24 -27 Conversely, a normal 12-hour CRP and a quantitative blood culture with Ͻ10 colony-forming units/mL or an incubation time to positive of Ͼ20 hours may suggest that the isolate is a contaminant.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Treatment of Neonates With Suspected Late-Onset Sepsis: A Survey of Neonatologists’ Practices

Rubin

Sánchez

Siegel³

et al. 2002

Pediatrics

151

111

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ABSTRACT.Objective. To ascertain current diagnostic and treatment practices for suspected late-onset sepsis in infants in neonatal intensive care units (NICUs) and identify areas that may benefit from clinical practice guidelines.Methods. During June 2000, we conducted a multicenter survey of neonatologists and infection control professionals regarding practices related to late-onset sepsis in NICUs at children's hospitals participating in the Pediatric Prevention Network.Results. Personnel at 35 hospitals with NICUs completed surveys; 34 were infection control professionals, and 278 were neonatology clinicians, primarily attending neonatologists or neonatology fellows. At these facilities, coagulase-negative staphylococci (CoNS) were the most frequent blood culture isolate from infants with lateonset sepsis accounting for 54% of bloodstream infections. When late-onset sepsis was suspected, 83% of clinicians drew only 1 blood culture when no central venous catheter was present or when a central vascular was present with no blood return. Thirty-two percent obtained 1 or more C-reactive protein concentration determinations. Sixty percent of clinicians prescribed a vancomycin-containing regimen for a 900 g, 3-week-old infant with suspected late-onset sepsis. The presence of a central venous catheter or shock increased empiric vancomycin use. The presence of methicillin-resistant Staphylococcus aureus in the NICU did not increase vancomycin use, but a vancomycin restriction policy decreased empiric vancomycin use. Clinicians at an individual NICU tended to have similar empiric antibiotic-prescribing practices: in 29 (83%) of 35 centers >75% of respondents had similar practice with regard to prescribing a vancomycin-containing regimen for empiric therapy. Forty-seven percent to 85% completed a full course of antimicrobials when a single blood culture was obtained and grew CoNS, but a significantly lower percentage of respondents (22%-47%) completed a full course when 1 of 2 blood cultures obtained grew CoNS. Eleven percent of respondents removed an umbilical catheter at the time of suspected sepsis, but fewer than 5% removed a nonumbilical central venous catheter for suspected sepsis. L ate-onset sepsis-invasive infection occurring in neonates older than 3 days-occurs in approximately 10% of all neonates and in Ͼ25% of very low birth weight infants (Յ1500 g) who are hospitalized in neonatal intensive care units (NICUs). 1 In NICUs, these infections are often associated with vascular catheters, and coagulase-negative staphylococci (CoNS) are the most commonly reported pathogens, accounting for Ͼ50% of bloodstream infections. 2,3 In this setting, the vast majority of CoNS are resistant to methicillin. NICU infants with suspected late-onset sepsis are typically treated with empiric antimicrobial therapy that often includes vancomycin. However, there are national recommendations that vancomycin use in hospitals be restricted because exposure of patients to vancomycin is a risk factor for emergence of vancomycinresistant ...

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Serial Serum C-Reactive Protein Levels in the Diagnosis of Neonatal Infection

Cited by 376 publications

References 51 publications

Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

Evaluation of IL-8-Concentrations in Plasma and Lysed EDTA-Blood in Healthy Neonates and Those with Suspected Early Onset Bacterial Infection

Evaluation and Treatment of Neonates With Suspected Late-Onset Sepsis: A Survey of Neonatologists’ Practices

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