Download Use of CRP to Determine Duration of Therapy in Neonatal Sepsis

ETSU Pediatrics CAT
Can CRP be Used to Shorten the Duration of Antibiotic Therapy
for Neonates with Late Onset Sepsis?
Jason Pryor MD and Whitney Gilley MD
Date of Initial Appraisal: 9/17/13
Clinical Question: Can CRP be used as an adjunct to blood culture to determine the
appropriate length of therapy in neonates with late onset sepsis?
Clinical Bottom Line
1. In an unblended, prospective, intervention trial with historical controls
consisting of 196 neonates, results support the use of serial CRP
measurements as a method of guiding duration of antibiotic therapy for late
onset neonatal sepsis.
2. The median amount of treatment days was 9 for the CRP-guided group
versus 16 for the historical control group.
3. Relapse rates for sepsis were relatively equal for the two groups.
Evidence Summary
1. 120 neonates with 138 episodes of sepsis were prospectively compared with
76 historical controls to determine the efficacy of CRP assessment to guide
antibiotic therapy for late onset sepsis occurring after 72 hours.
2. Exclusion Criteria: Age >28 days, development of site-specific infection, and
central venous catheter-related sepsis.
3. Participants in the prospective study group had CRP levels measured at the
time of diagnosis of LOS and at 48 hour intervals until levels were less than
or equal to 12.
4. Primary measure was duration of antibiotic therapy. Secondary measures
were relapsing sepsis within 72 hours of discontinuing antibiotic therapy
and overall mortality rate.
5. Of the 120 patients in the CRP study group, average length of antibiotic
therapy was 9 days compared to 16 days in the historical control group.
6. Relapse rate in the CRP study group was 1.4% compared to 2.4% in the
historical group.
Comments
1. Of note, the use of maternal perinatal antibiotic therapy was not recorded
and could have the potential to affect the outcome of the study.
2. Obtaining serial levels of CRP significantly improves the diagnostic
sensitivity.
3. CRP levels can be affected by caesarian section and low birth weight.
© 2014 Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State
University
ETSU Pediatrics CAT
4. Limitations to the study include: nonrandomization, nonblinding, lack of
reporting of maternal antibiotics, and small sample size of term and
appropriate for gestational age neonates.
References
1. Renato C, Barbosa J, Pedrosa T, et al. C-Reactive Protein-Guided Approach
May Shorten Length of Antimicrobial Treatment of Culture-Proven LateOnset Sepsis. An Intervention Study. The Brazilian Journal of Infectious
Diseases. 2007;11:240-245.
2. Benitz W, Han M, Madan A, et al. Serial Serum C-Reactive Protein Levels in
the Diagnosis of Neonatal Infection. Pediatrics. 1998;102;e41
CAT Editor: Dr. Karen E. Schetzina
Last updated: September 17, 2013
© 2014 Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State
University