التفاصيل البيبلوغرافية
| العنوان: |
Use of a Computerized C-Reactive Protein (CRP) Based Sepsis Evaluation in Very Low Birth Weight (VLBW) Infants: A Five-Year Experience. |
| المؤلفون: |
Coggins, Sarah A.1, Wynn, James L.2, Hill, Melissa L.2, Slaughter, James C.3, Ozdas-Weitkamp, Asli4 hendrik.weitkamp@vanderbilt.edu, Jalloh, Osman4, Waitman, L. Russell4, Carnevale, Randy J.4, Weitkamp, Jörn-Hendrik2 |
| المصدر: |
PLoS ONE. Nov2013, Vol. 8 Issue 11, p1-10. 10p. |
| مصطلحات موضوعية: |
*C-reactive protein, *SEPSIS, *LOW birth weight, *DECISION making in clinical medicine, *PREMATURE infants, *COMPUTER algorithms, *ANTIBIOTICS |
| مستخلص: |
Background: Serial C-reactive protein (CRP) values may be useful for decision-making regarding duration of antibiotics in neonates. However, established standard of practice for its use in preterm very low birth weight (<1500 g, VLBW) infants are lacking. Objective: Evaluate compliance with a CRP-guided computerized decision support (CDS) algorithm and compare characteristics and outcomes of compliant versus non-compliant cases. Measure correlation between CRPs and white blood count (WBC) indices. Methods: We examined 3 populations: 1) all preterm VLBW infants born at Vanderbilt 2006–2011 – we assessed provider compliance with CDS algorithm and measured relevant outcomes; 2) all patients with positive blood culture results admitted to the Vanderbilt NICU 2006–2012 – we tested the correlation between CRP and WBC results within 7 days of blood culture phlebotomy; 3) 1,000 randomly selected patients out of the 7,062 patients admitted to the NICU 2006–2012 – we correlated time-associated CRP values and absolute neutrophil counts. Results: Of 636 VLBW infants in cohort 1), 569 (89%) received empiric antibiotics for suspected early-onset sepsis. In 409 infants (72%) the CDS algorithm was followed; antibiotics were discontinued ≤48 hours in 311 (55%) with normal serial CRPs and continued in 98 (17%) with positive CRPs, resulting in significant reduction in antibiotic exposure (p<0.001) without increase in complications or subsequent infections. One hundred sixty (28%) were considered non-compliant because antibiotics were continued beyond 48 hours despite negative serial CRPs and blood cultures. Serial CRPs remained negative in 38 (12%) of 308 blood culture-positive infants from cohort 2, but only 4 patients had clinically probable sepsis with single organisms and no immunodeficiency besides extreme prematurity. Leukopenia of any cell type was not linked with CRPs in cohorts 2 and 3. Conclusions: CDS/CRP-guided antibiotic use is safe and effective in culture-negative VLBW infants. CRP results are not affected by low WBC indices. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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