Usefulness of consecutive CRP measurements in follow-up of treatment for severe CAP

¹ Division of Medicine, Dept of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, The Netherlands
² Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.; and Paediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
³ Division of Medicine, Dept of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, The Netherlands; and Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, The Netherlands

^* To whom correspondence should be addressed. E-mail: I.M.Hoepelman{at}umcutrecht.nl.

	Abstract

Despite the introduction of new inflammatory markers, C-reactive protein (CRP) remains commonly used in patients hospitalised with severe infections. However, evidence on the usefullness of consecutive CRP measurements is still unclear. We therefore studied the clinical relevance of consecutive CRP measurements in follow-up of antibiotic treatment in patients with severe community-acquired pneumonia (CAP).

In a prospective multicenter trial, CRP levels were measured on admission, day 3, and 7. Patients were clinically followed for 28 days.

Etiology could be determined in 137 (47.4%) of the 289 patients included. In 122 (38.8%) patients, initial antibiotic therapy was appropriate. A decline of <60% in CRP levels in 3 days and a decline of <90% in CRP levels in 7 days were both associated with an increased risk of having recieved inapproriate empiric antibiotic treatment (day 0–3, odds ratio (OR) 6.98, 95% confidence interval (CI) 1.56–31.33) and (day 0–7, OR 3.74, 95% CI 1.12–13.77).

In conclusion, consecutive CRP measurements are useful in the first week in follow-up of antibiotic treatment for severe CAP when taking the causative micro-organism and use of steroids into account. A delayed normalisation of CRP levels is associated with a higher risk of having received inappropriate antibiotic treatment.

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