C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia
Objectives: To explore the negative predictive value (NPV) of C-reactive protein (CRP) at admission to exclude complicated disease manifestations of pneumococcal disease.Methods: A Dutch multicentre retrospective cohort study was conducted between 01-01-2012 and 30-06-2020. Adults with positive bloo...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-10-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971221006433 |
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| author | Milou J.V. Serbée Elisabeth A. Dulfer Kirsten K.T. Dirkx Ron Bosboom Bas Robberts Heiman F.L. Wertheim Bert Mulder Marien I. de Jonge Carel F. Schaars Caroline M.A. Swanink Amelieke J.H. Cremers |
| author_facet | Milou J.V. Serbée Elisabeth A. Dulfer Kirsten K.T. Dirkx Ron Bosboom Bas Robberts Heiman F.L. Wertheim Bert Mulder Marien I. de Jonge Carel F. Schaars Caroline M.A. Swanink Amelieke J.H. Cremers |
| author_sort | Milou J.V. Serbée |
| collection | DOAJ |
| description | Objectives: To explore the negative predictive value (NPV) of C-reactive protein (CRP) at admission to exclude complicated disease manifestations of pneumococcal disease.Methods: A Dutch multicentre retrospective cohort study was conducted between 01-01-2012 and 30-06-2020. Adults with positive blood cultures for Streptococcus pneumoniae, whose CRP was measured at admission and whose infection focus was known, were included. Electronic medical and microbiological records were reviewed.Results: Of the 832 bacteraemic patients enrolled, 30% had complicated manifestations of pneumococcal disease; most frequent were pleural effusion (8.9%), pleural empyema (5.4%) and meningitis (7.5%). Compared to solitary pneumonia, patients with pleural effusion and empyema presented with higher CRP levels. Although low CRP levels did not exclude complicated disease in general, a CRP level < 114 mg/L at admission could reliably exclude empyema among adult pneumonia patients with an NPV of 93% and a specificity of 26%. However, in cases where pleural fluid was present, CRP levels were mostly > 114 mg/L, such that suspicion of empyema could only be ruled out in a minority of cases (10%).Conclusions: Complicated manifestations are prevalent in adult pneumococcal bacteraemia. Low blood CRP levels can reliably exclude the development of pulmonary empyema. Practical value may be largest in settings without thoracic imaging at hand. |
| first_indexed | 2024-12-17T19:34:11Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-17T19:34:11Z |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-b4e9ba77e2ff4a659f4b6bd0aae3da1e2022-12-21T21:35:11ZengElsevierInternational Journal of Infectious Diseases1201-97122021-10-01111172178C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemiaMilou J.V. Serbée0Elisabeth A. Dulfer1Kirsten K.T. Dirkx2Ron Bosboom3Bas Robberts4Heiman F.L. Wertheim5Bert Mulder6Marien I. de Jonge7Carel F. Schaars8Caroline M.A. Swanink9Amelieke J.H. Cremers10Department of Clinical Microbiology and Immunology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands; Department of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Corresponding author: Department of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the NetherlandsDepartment of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Deparment of Internal Medicine, Pantein, Dokter Kopstraat 1, 5835 DV, Beugen, the NetherlandsDepartment of Clinical Microbiology, Canisius-Wilhelmina Ziekenhuis, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the NetherlandsDepartment of Clinical Microbiology and Immunology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, the NetherlandsDeparment of Pulmonary Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the NetherlandsDepartment of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the NetherlandsDepartment of Clinical Microbiology, Canisius-Wilhelmina Ziekenhuis, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the NetherlandsDepartment of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the NetherlandsDeparment of Internal Medicine, Pantein, Dokter Kopstraat 1, 5835 DV, Beugen, the NetherlandsDepartment of Clinical Microbiology and Immunology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, the NetherlandsDepartment of Clinical Microbiology and Immunology, Rijnstate, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands; Department of Clinical Microbiology, Radboud Centre for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the NetherlandsObjectives: To explore the negative predictive value (NPV) of C-reactive protein (CRP) at admission to exclude complicated disease manifestations of pneumococcal disease.Methods: A Dutch multicentre retrospective cohort study was conducted between 01-01-2012 and 30-06-2020. Adults with positive blood cultures for Streptococcus pneumoniae, whose CRP was measured at admission and whose infection focus was known, were included. Electronic medical and microbiological records were reviewed.Results: Of the 832 bacteraemic patients enrolled, 30% had complicated manifestations of pneumococcal disease; most frequent were pleural effusion (8.9%), pleural empyema (5.4%) and meningitis (7.5%). Compared to solitary pneumonia, patients with pleural effusion and empyema presented with higher CRP levels. Although low CRP levels did not exclude complicated disease in general, a CRP level < 114 mg/L at admission could reliably exclude empyema among adult pneumonia patients with an NPV of 93% and a specificity of 26%. However, in cases where pleural fluid was present, CRP levels were mostly > 114 mg/L, such that suspicion of empyema could only be ruled out in a minority of cases (10%).Conclusions: Complicated manifestations are prevalent in adult pneumococcal bacteraemia. Low blood CRP levels can reliably exclude the development of pulmonary empyema. Practical value may be largest in settings without thoracic imaging at hand.http://www.sciencedirect.com/science/article/pii/S1201971221006433Streptococcus pneumoniaeC-reactive proteinInvasive pneumococcal diseaseEmpyema |
| spellingShingle | Milou J.V. Serbée Elisabeth A. Dulfer Kirsten K.T. Dirkx Ron Bosboom Bas Robberts Heiman F.L. Wertheim Bert Mulder Marien I. de Jonge Carel F. Schaars Caroline M.A. Swanink Amelieke J.H. Cremers C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia International Journal of Infectious Diseases Streptococcus pneumoniae C-reactive protein Invasive pneumococcal disease Empyema |
| title | C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia |
| title_full | C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia |
| title_fullStr | C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia |
| title_full_unstemmed | C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia |
| title_short | C-reactive protein to rule out complicated pneumococcal disease manifestations: a retrospective cohort study in adults with pneumococcal bacteraemia |
| title_sort | c reactive protein to rule out complicated pneumococcal disease manifestations a retrospective cohort study in adults with pneumococcal bacteraemia |
| topic | Streptococcus pneumoniae C-reactive protein Invasive pneumococcal disease Empyema |
| url | http://www.sciencedirect.com/science/article/pii/S1201971221006433 |
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