Time Course of C-Reactive Protein and Procalcitonin Levels During the Treatment of Acute Bacterial Skin Infections

Jenkins, Timothy C; Haukoos, Jason S.; Cotton, Eleanor; Weitzenkamp, David; Frank, Daniel N.; Burman, William J.

doi:10.1093/ofid/ofy029

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…In line with the only other cellulitis treatment duration trial, we measured seven symptoms using a symptom severity scale (the cellulitis severity score [9]) set arbitrary borders, and combined it with the need for additional antibiotics at a later time point. Pilot studies on procalcitonin-guided therapy duration in cellulitis patients show conflicting results, so further biomarker studies are warranted [29,30].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic treatment for 6 days versus 12 days in patients with severe cellulitis: a multicentre randomized, double-blind, placebo-controlled, non-inferiority trial

Cranendonk

Opmeer

Agtmael

et al. 2020

Clinical Microbiology and Infection

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a b s t r a c tObjectives: To investigate whether antibiotic treatment of 6 days' duration is non-inferior to treatment for 12 days in patients hospitalized for cellulitis. Methods: This multicentre, randomized, double-blind, placebo-controlled, non-inferiority trial enrolled adult patients hospitalized for severe cellulitis who were treated with intravenous flucloxacillin. At day 6 participants with symptom improvement who were afebrile were randomized between an additional 6 days of oral flucloxacillin or placebo in a 1:1 ratio, stratified for diabetes and hospital. The primary outcome was cure by day 14, without relapse by day 28. Secondary outcomes included a modified cure assessment and relapse rate by day 90. Results: Between August 2014 and June 2017, 151 of 248 included participants were randomized. The intention-to-treat population consisted of 76 and 73 participants allocated to 12 and 6 days of antibiotic therapy, respectively (mean age 62 years, 67% males, 24% diabetics); 38/76 (50.0%) and 36/73 (49.3%) were cured in the 12-and 6-day groups respectively (ARR 0.7 percentage points, 95%CI: e15.0 to 16.3). Cure rates were 56/76 (73.7%) and 49/73 (67.1%) with the modified cure assessment (ARR 6.6, 95%CI:e8.0 to 20.8). After initial cure without relapse, day 90 relapse rates were higher in the 6-day group (6% versus 24%, p < 0.05). Conclusions: Given the wide confidence intervals, we can neither confirm nor refute our hypothesis that 6 days of therapy is non-inferior to 12 days of therapy. However, a 6-day course resulted in significantly more frequent relapses by day 90. These findings require confirmation in future studies. D.R. Cranendonk, Clin Microbiol Infect 2020;26:606

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Section: Discussionmentioning

confidence: 99%

Antibiotic treatment for 6 days versus 12 days in patients with severe cellulitis: a multicentre randomized, double-blind, placebo-controlled, non-inferiority trial

Cranendonk

Opmeer

Agtmael

et al. 2020

Clinical Microbiology and Infection

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“…Chung et al5) reported that the measurement of serum PCT is useful in post-spinal surgery fever of unknown origin. Jeong et al12) reported that serum PCT is less sensitive than CRP in spinal infection and that other infections than spinal infection should be confirmed when the serum PCT increases in order to provide appropriate antibiotic treatment 123101114). Maus et al17) reported that PCT is a biomarker that is unsuitable for diagnosis and monitoring of spinal infection.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal infection is diagnosed through physical examination, laboratory tests, or radiologic studies. Typical laboratory tests performed to diagnose spinal infection include white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) 345101112141516)…”

Section: Introductionmentioning

confidence: 99%

Changes of Biomarkers before and after Antibiotic Treatment in Spinal Infection

Lee

Lim

Choi

et al. 2019

Korean J Neurotrauma

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Objective: The laboratory biomarkers used to diagnose spinal infection include white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Recently, procalcitonin (PCT) has been used as a biomarker to distinguish between bacterial infection and non-bacterial infection. We aimed to compare the changes of conventional biomarker and PCT in patients with spinal infection before and after antibiotic treatment. Methods: ESR, CRP, WBC counts, and PCT were measured in 29 patients diagnosed with pyogenic spinal infection at our hospital between May 2016 and December 2018 prior to antibiotic administration. After antibiotic administration, the values were followed up for 4 weeks at 1-week intervals. Results: A total of 29 patients were enrolled, with a mean age of 67.8 years, consisting of 16 men and 13 women. Twenty-five patients had lumbar infections, and 2 each had cervical and thoracic infections. The mean ESR, CRP, PCT, and WBCs decreased at week 4 of antibiotic treatment compared to their baseline values. CRP and WBCs were significantly decreased after 4 weeks of treatment compared to before treatment. The mean ESR and PCT was not statistically significant compared to pretreatment and after antibiotic treatment (p-value>0.05). Conclusion: Among several biomarker, CRP and WBCs are biomarkers that can aid early evaluation of the effects of antibiotic treatment in pyogenic spondylitis. Although PCT did not have statistical significance, it can be used as a biomarker that reflects the effect of antibiotic and severity of infection.

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“…Biomarkers of inflammation such as erythrocyte sedimentation rate (ESR), fibrinogen (FIB), C-reactive protein (CRP), procalcitonin (PCT) or haemogram parameters like neutrophil/lymphocyte count ratio (NLCR) or mean platelet volume (MPV) are traditionally used in cases of sepsis. Their usefulness is not only related to the early recognition of sepsis and to the assessment of disease severity at admission, but also to the prediction of the prognosis and the response to antimicrobial therapy [4].…”

Section: Introductionmentioning

confidence: 99%

The Dynamical Assessment of Inflammatory Biomarkers in Predicting the Outcome of Septic Patients and the Response to Antimicrobial Therapy

Orfanu

Aramă

Popescu

et al. 2020

The Journal of Critical Care Medicine

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Aims:To evaluate the kinetics of inflammatory biomarkers in septic patients in order to identify the most reliable predictor of unfavorable outcome. Methods: A prospective analysis of septic patients was performed. Median levels of neutrophil/lymphocyte count ratio, fibrinogen, C-reactive protein and procalcitonin were dynamically assessed and comparatively analyzed. Results: Seventy-seven patients were included. Descendent kinetic patterns were registered for all biomarkers, except C-reactive protein. At 24 hours, neutrophil/lymphocyte count ratio significantly decreased in 42.85% of cases, procalcitonin in 37.33%, C-reactive protein in 16.12% and fibrinogen in 1.58% of cases. At 72 hours, procalcitonin decreased to one-half in 70% of cases and neutrophil/lymphocyte count ratio in 67.53% of cases. Conclusions: Neutrophil/lymphocyte count ratio and procalcitonin significantly decreased in the first 72 hours, while C-reactive protein increased in the first 24 hours. The proportions of patients with major decrease of baseline values were higher for neutrophil/lymphocyte count ratio and procalcitonin.

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Time Course of C-Reactive Protein and Procalcitonin Levels During the Treatment of Acute Bacterial Skin Infections

Cited by 7 publications

References 10 publications

Antibiotic treatment for 6 days versus 12 days in patients with severe cellulitis: a multicentre randomized, double-blind, placebo-controlled, non-inferiority trial

Antibiotic treatment for 6 days versus 12 days in patients with severe cellulitis: a multicentre randomized, double-blind, placebo-controlled, non-inferiority trial

Changes of Biomarkers before and after Antibiotic Treatment in Spinal Infection

The Dynamical Assessment of Inflammatory Biomarkers in Predicting the Outcome of Septic Patients and the Response to Antimicrobial Therapy

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