title: Characteristics of patients with community-acquired bacteremia who have low levels of C-reactive protein (≤20 mg/L).
abstract: OBJECTIVE
  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.affiliation: Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark. Electronic address: fredrikkeknudtzen@hotmail.com.
authors.forename: Fredrikke Christie
authors.initials: FC
authors.lastname: Knudtzen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark.
authors.forename: Stig Lønberg
authors.initials: SL
authors.lastname: Nielsen
authors.affiliation: 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.
authors.forename: Kim Oren
authors.initials: KO
authors.lastname: Gradel
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Kloevervaenget 25, Entrance 63-65, 5000 Odense C, Denmark.
authors.forename: Annmarie Touborg
authors.initials: AT
authors.lastname: Lassen
authors.affiliation: Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2nd Floor, 5000 Odense C, Denmark.
authors.forename: Hans Jørn
authors.initials: HJ
authors.lastname: Kolmos
authors.affiliation: Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2nd Floor, 5000 Odense C, Denmark.
authors.forename: Thøger Gorm
authors.initials: TG
authors.lastname: Jensen
authors.affiliation: Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, Entrance 40, 5000 Odense C, Denmark.
authors.forename: Pernille Just
authors.initials: PJ
authors.lastname: Vinholt
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark.
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D017714:Community-Acquired Infections; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Coagulase-negative staphylococci; Community-acquired bacteremia; Hemolytic streptococci