Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug 11:15:320.
doi: 10.1186/s12879-015-1069-7.

Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L)

Mei-Yin Lai  1   2 , Ming-Horng Tsai  3   4 , Chiang-Wen Lee  5   6 , Ming-Chou Chiang  7   8 , Reyin Lien  9   10 , Ren-Huei Fu  11   12 , Hsuan-Rong Huang  13   14 , Shih-Ming Chu  15   16   17 , Jen-Fu Hsu  18   19   20
Affiliations

Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L)

Mei-Yin Lai et al. BMC Infect Dis. .

Abstract

Background: Elevated C-reactive protein (CRP) level is widely used in clinical practice as a marker to distinguish between neonates with or without sepsis. However, some neonates with bacteremia have a CRP level within the normal range and they are not well characterized.

Methods: All episodes of neonatal culture-proven bloodstream infections (BSIs) between July 2004 and June 2012 were enrolled. Patients characteristics were compared for three CRP groups (low, ≤ 10 mg/L; intermediate, 11-100 mg/L; and high, > 100 mg/L) using the Chi-square test and one-way ANOVA. The sepsis-attributable mortality rates were compared using logistic regression analyses.

Results: Of 986 episodes of neonatal BSI, 247 (25.1 %) had CRP ≤10 mg/L at the onset of clinical sepsis. In the low CRP group, patients had lower gestational age and birth weight, and an earlier occurrence of BSI. Patients with underlying gastrointestinal pathology, renal disorders, cholestasis, and pulmonary hypertension had a non-significant elevated CRP level at the onset of sepsis. In the blood culture of the low CRP group, coagulase-negative staphylococci (CoNS) were relatively more common (55.9 %, p < 0.001) than the other two groups, although one-fourth were infected with gram-negative bacilli (19.0 %), fungi (2.8 %), or polymicrobial pathogens (3.6 %). Of the BSIs with initial low CRP, 29.1 % were treated with inadequate antibiotics, 13.0 % progressed to septic shock, and 5.3 % had infectious complications. The sepsis-attributable mortality rate was lower in the low CRP group (4.9 %) than in the high CRP group (13.6 %).

Conclusions: A considerable proportion of neonatal BSIs had a normal or low initial CRP level (≤10 mg/L), which was more likely to occur in low birth weight or extremely preterm infants, those with earlier onset of sepsis, and those infected with CoNS. Plasma CRP level should not be used to rule out severe culture-proven sepsis or guide the empirical choice of antibiotics.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Survival following positive blood culture from 986 episodes of neonatal culture-proven bloodstream infection. The Kaplan-Meier graph is stratified by three different CRP groups: low, ≤ 10 mg/L; intermediate, 11–100 mg/L; and high, > 100 mg/L
See this image and copyright information in PMC

References

    1. Tsai MH, Hsu JF, Chu SM, Lien R, Huang HR, Chiang MC, et al. Incidence, clinical characteristics, and risk factors of adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J. 2014;33:e7–13. doi: 10.1097/INF.0b013e3182a72ee0. - DOI - PubMed
    1. Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B. Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics. 2002;109:34–9. doi: 10.1542/peds.109.1.34. - DOI - PubMed
    1. Verstraete E, Boelens J, De Coen K, Claeys G, Vogelaers D, Vanhaesebrouck P, et al. Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992–2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol. 2014;35:511–8. doi: 10.1086/675836. - DOI - PubMed
    1. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110:285–91. doi: 10.1542/peds.110.2.285. - DOI - PubMed
    1. Mitha A, Foix-L’Helias L, Arnaud C, Marret S, Vieux R, Aujard Y, et al. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics. 2013;132:e372–80. doi: 10.1542/peds.2012-3979. - DOI - PubMed

MeSH terms