Fredrikke Christie Knudtzen1, Stig Lønberg Nielsen2, Kim Oren Gradel3, Annmarie Touborg Lassen4, Hans Jørn Kolmos5, Thøger Gorm Jensen5, Pernille Just Vinholt6, Court Pedersen2. 1. Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark. Electronic address: fredrikkeknudtzen@hotmail.com. 2. Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark. 3. Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, Entrance 101, 4th Floor, 5000 Odense C, Denmark. 4. Department of Emergency Medicine, Odense University Hospital, Kloevervaenget 25, Entrance 63-65, 5000 Odense C, Denmark. 5. Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2nd Floor, 5000 Odense C, Denmark. 6. Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, Entrance 40, 5000 Odense C, Denmark.
Abstract
OBJECTIVES: To characterize patients presenting with community-acquired bacteremia and a low C-reactive protein (CRP) plasma level at date of bacteremia. METHODS: Population-based cohort study. Patient characteristics were compared for three CRP groups (≤20 mg/L, 21-100 mg/L and >100 mg/L) using chi-square test and oneway anova. The 30-day mortality rates were compared using logistic regression analyses. RESULTS: Of the 2017 patients included, 193 (9.6%) had a CRP ≤20 mg/L. These patients were younger, more likely to be male, overrepresented in the intensive care unit and had more comorbidities. In blood cultures from the low CRP group hemolytic streptococci and coagulase-negative staphylococci were found relatively more common, whereas Streptococcus pneumoniae or Staphylococcus aureus were found relatively less common compared to the other CRP groups. The majority of patients with an initial low CRP mounted a CRP response the following days. The 30-day mortality rate was lower in the low CRP group (13.5%) than in the group with CRP >100 mg/L (20.6%). CONCLUSIONS: A considerable proportion of patients with community-acquired bacteremia has a normal or low initial CRP level. The plasma CRP level should not be used to rule out serious infection or withhold antibiotic therapy.
OBJECTIVES: To characterize patients presenting with community-acquired bacteremia and a low C-reactive protein (CRP) plasma level at date of bacteremia. METHODS: Population-based cohort study. Patient characteristics were compared for three CRP groups (≤20 mg/L, 21-100 mg/L and >100 mg/L) using chi-square test and oneway anova. The 30-day mortality rates were compared using logistic regression analyses. RESULTS: Of the 2017 patients included, 193 (9.6%) had a CRP ≤20 mg/L. These patients were younger, more likely to be male, overrepresented in the intensive care unit and had more comorbidities. In blood cultures from the low CRP group hemolytic streptococci and coagulase-negative staphylococci were found relatively more common, whereas Streptococcus pneumoniae or Staphylococcus aureus were found relatively less common compared to the other CRP groups. The majority of patients with an initial low CRP mounted a CRP response the following days. The 30-day mortality rate was lower in the low CRP group (13.5%) than in the group with CRP >100 mg/L (20.6%). CONCLUSIONS: A considerable proportion of patients with community-acquired bacteremia has a normal or low initial CRP level. The plasma CRP level should not be used to rule out serious infection or withhold antibiotic therapy.
Authors: Johan Courjon; Elisa Demonchy; Nicolas Degand; Karine Risso; Raymond Ruimy; Pierre-Marie Roger Journal: Ann Clin Microbiol Antimicrob Date: 2017-05-19 Impact factor: 3.944
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