Value of C-reactive protein in the detection of bacterial contamination at the time of presentation in drug-induced aspiration pneumonia.
OBJECTIVE
To compare the plasma concentration of C-reactive protein (CRP) with traditional markers for diagnosis of bacterial pneumonia in patients with suspected aspiration.


METHODS
Prospective, nonrandomized, controlled study of consecutive hospital admissions.


METHODS
Toxicology ICU in a university hospital.


METHODS
Acutely poisoned comatose patients admitted to the hospital with suspicion of aspiration pneumonia.


METHODS
Distal protected catheter sampling per fiberoptic bronchoscopy and bacteriologic culture were employed as a standard to detect the bacterial component of suspected aspiration pneumonia. Plasma CRP concentrations, temperature, and WBC count were measured on hospital day 1.


RESULTS
Sixty-six patients were evaluated. Thirty-two had bacterial contamination by positive culture (> or =10(3) cfu/mL). Multiple receiver-operating characteristic (ROC) curves were used to compare each parameter for detection of infection secondary to aspiration. The ROC curve of CRP concentrations showed that a CRP >75 mg/L is associated with bacterial contamination with a sensitivity of 87%, specificity of 76%, positive predictive value of 78%, and negative predictive value of 87%. ROC curves of temperature and WBC count demonstrated poor diagnostic value of these markers in indicating the bacterial component of suspected aspiration pneumonia.


CONCLUSIONS
Early measurement of CRP is useful for the diagnosis of aerobic bacterial content of aspiration pneumonia and perhaps in determining the need for invasive bacteriologic sampling. Temperature and WBC count are poor indicators of bacterial infection of aspiration pneumonia in poisoned patients.
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Service du Pr C. Bismuth, Réanimation Toxicologique INSERM U26, Hôpital Fernand Widal, Paris, France.
Borron
S W
SW
Vicaut
E
E
Giraudeaux
V
V
Lapostolle
F
F
Bekka
R
R
Baud
F J
FJ
D000328:Adult; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011015:Pneumonia, Aspiration / Q000097:blood* / Q000139:chemically induced* / Q000150:complications; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011041:Poisoning / Q000150:complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
D002097:C-Reactive Protein