The Role of C-reactive Protein Estimation in Determining the Duration of Antibiotic Therapy in Neonatal Sepsis

Abstract

Introduction: Septicemia is globally considered the most important cause of neonatal morbidity and fatality. Serum C-Reactive Protein (CRP) is an acute phase reactant, which is brought out in response to the inflammatory reaction. It is prophesied to drop down speedily after the coherent weeding out of microbial incitation due to the short half-life of CRP. CRP levels reflect the individual's association between microbial infection and defensive mechanisms. Methods: This hospital-based cross-sectional study included 150 admitted patients with suspected sepsis in the Department of Pediatrics, Rajendra Institute Medical Sciences (RIMS), Ranchi, India, over a study period of one year (2020 to 2021). CRP was estimated on the day of admission and repeated after 72 hours, on the fifth day, and on the seventh day for serial values of CRP, and the findings were compared by making three groups. Further, the research participants were designated to three different groups according to the CRP estimation levels. Results: Out of the 150 assumed neonatal septicemia patients, antibiotics were paused in 42 neonates (28%) within 72 hours. In group 2, 8% of neonates’ antibiotics were stopped in five days, and a total of 102 neonates (68%) could be discharged on the seventh day of antibiotic therapy as their CRPs became negative on the third day and seventh day consecutively, along with negative blood culture reports. In group 3, antibiotics of 48 neonates (32%) were continued beyond seven days. Conclusion: CRP has a skyscraping specificity and negative predictive values (NPV); thus, by estimating serial CRPs, the antibiotic therapy duration can be determined, which further helps determine the period of hospitalization.

The clinical significance of CRP and IL-6 in early recognition of neonatal sepsis

“…In our study, at cut off level of >10mg/L CRP had sensitivity of 93% with specificity of 76% showing that nCRP is better predictor of neonatal sepsis. The outcome of another study supported our findings that CRP had high sensitivity with NPV of 98-100% in early detection of neonatal sepsis [22]. So, both CRP and IL-6 should be used for rapid and early detection of neonatal sepsis as one has high sensitivity and other shows high specificity.…”

Diagnostic Values of Blood Indices for Neonatal Sepsis

“…It is important to highlight that we only recorded the initial CRP at the time of culture-positive and did not include serial CRP measurements. If we had considered serial CRP measurements, there might have been a higher proportion of positive CRP results, as Chaudhuri et al discussed the role of serial CRP in the diagnosis of neonatal sepsis (22). In addition, we found a significant difference in CRP levels (P = 0.012) between cases of Gram-positive, Gram-negative, and fungal sepsis.…”

Sepsis neonatal: factores de riesgo, sintomatología clínica y marcadores diagnósticos.

“…Autores como: Ying (Iroh Tam & Bendel, 2017), Sharma (Sharma et al, 2017), Tzialla (Tzialla et al, 2018), Kambale (Bunduki & Adu-Sarkodie, 2020), Wang (Wang et al, 2020), Cantey (Cantey & Lee, 2021), Burstein (Burstein et al, 2021), Yochpaz (Friedman et al, 2021), Nguyen (Duc Toan et al, 2022), Kumar (Chaudhuri et al, 2022), Yochpaz (Yochpaz et al, 2020), indican que la prueba de proteína C reactiva > 2 veces el valor normal, tiene una utilidad a nivel mundial muy alta para un diagnóstico oportuno y rápido de sepsis neonatal por la sensibilidad y especificidad de la prueba (76,92% y 53,49%), mientras que por la precisión de diagnóstico es 70,07%. Otros estudios realizados por Fleischmann (Fleischmann et al, 2021), Wang (Wang et al, 2020), Cantey (Cantey & Lee, 2021), Nguyen (Duc Toan et al, 2022, Salsábila (Salsabila et al, 2022), Kumar (Chaudhuri et al, 2022), Minichil Worku (Worku et al, 2022), atribuyen que la importancia de los parámetros del hemograma completo en el diagnóstico de la sepsis neonatal es por la sensibilidad de recuento total de leucocitos, hemoglobina, recuentos de linfocitos y recuento absoluto de neutrófilos de 64,8; 68; 33,6 y 49,6% y la especificidad 64,8, 53,6, 83,2 y 90,4 %. En el análisis de la información autores como Li (Xiaojuan Li et al, 2021), Eichberger (Eichberger et al, 2022), resaltan el uso de marcadores de citocinas (TNF, IL-1, IL-6, IL-8, IL-10) específicamente el IL -6 como marcador de sepsis porque hay un rápido aumento en la concentración justo antes de a determinación del PCR, aumentan principalmente en respuesta a infecciones bacterianas y los niveles de procalcitonina > 2 veces el valor normal, este marcador aumenta rápidamente de 2 a 4 horas después de la exposición de una infección.…”