C-reactive protein: a tool in the follow-up of nosocomial pneumonia.
OBJECTIVE
The aim of this study was to examine the clinical usefulness of serial C-reactive protein (CRP) dosages in patients with nosocomial pneumonia (NP).


METHODS
Prospective and observational study performed in a 24-beds Intensive Care Unit. Sixty four patients with NP, including non-ventilated patients and those with ventilator-associated pneumonia were included. Daily measurements of CRP were performed and CRP ratios were calculated from the day of antibiotic prescription (D0) until day 10. Patients were than classified according to the CRP ratios in 2 groups: 'good' response (CRP ratios lower than 0.67 at day 10) and 'poor' response (non-response or bi-phasic response).


RESULTS
The poor response group (n = 34) had a mortality rate of 53% in comparison to 20% in the good response group (n = 30) (RR = 2.65; 95% CI, 1.21-5.79, p = 0.01). Significant differences between the two groups were found on CRP ratios at Day 4 (p = 0.01). The adequacy of antibiotic therapy was much lower in the group poor response in comparison to the group good response, 14% vs. 67% (p = 0.008), respectively.


CONCLUSIONS
Daily CRP measurements in patients with nosocomial pneumonia may be useful in the identification of patients with poor outcome, as early as day 4, and detect patients with inappropriate antimicrobial therapy.
Moreno
Marcelo Spegiorin
MS
Faculdade de Medicina de São José do Rio Preto Medical School, Serviço de Terapia Intensiva do Hospital de Base, Avenida Brigadeiro Faria Lima 5544, CEP 15090-000, São Jose do Rio Preto, SP, Brazil.
Nietmann
Henrique
H
Matias
Celso Murilo
CM
Lobo
Suzana Margareth
SM
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000032:analysis*; D003428:Cross Infection / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000188:drug therapy / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D002097:C-Reactive Protein