Franz A R, Steinbach G, Kron M, Pohlandt F
Department of Pediatrics, Division of Neonatology and Pediatric Critical Care, University of Ulm, Germany.
Pediatrics. 1999 Sep;104(3 Pt 1):447-53. doi: 10.1542/peds.104.3.447.
To examine whether the determination of interleukin 8 (IL-8) and C-reactive protein (CRP) in neonates with suspected nosocomial bacterial infection (NBI) is feasible and cost-effective in reducing antibiotic therapy.
Between April 1996 and May 1997, IL-8 was measured 260 times along with blood cultures, CRP, and immature-to-total-neutrophil (IT) ratio for suspected NBI in term and preterm neonates. All infants were retrospectively analyzed for NBI. Sensitivity, specificity, positive and negative predictive values, and 95% confidence intervals were calculated for IL-8, CRP, and IT ratio. Receiver-operating characteristic curves were analyzed to determine optimal thresholds. Between June 1997 and June 1998, IL-8 was measured 215 times in newborn infants with suspected NBI and the decision to start antibiotic therapy was based on increased IL-8 and/or CRP values. A cost-effectiveness analysis was performed and sensitivity, specificity, and receiver-operating characteristic curves were reevaluated.
At the first suspicion of NBI, the combination of IL-8 >/= 53 pg/mL and/or CRP >10 mg/L detected culture-proven NBI with 96% sensitivity. The combined culture-proven and clinical NBI were detected with 93% sensitivity and 80% specificity. The use of IL-8 reduced unnecessary antibiotic therapy for suspected NBI by 73% and was cost-effective when compared with initiating antibiotic therapy based on clinical signs alone or based on clinical signs and an increased IT ratio and/or CRP.
The combination of IL-8 and/or CRP is a reliable and early test for the diagnosis of NBI in newborn infants. Using the combination of IL-8 and/or CRP to restrict antibiotic therapy to truly infected infants reduces unnecessary antibiotic therapy and is cost-effective.
探讨检测疑似医院获得性细菌感染（NBI）新生儿的白细胞介素8（IL-8）和C反应蛋白（CRP）对于减少抗生素治疗是否可行且具有成本效益。
在1996年4月至1997年5月期间，对足月儿和早产儿疑似NBI的情况进行了260次IL-8检测，同时检测血培养、CRP以及未成熟中性粒细胞与总中性粒细胞（IT）比值。对所有婴儿进行NBI回顾性分析。计算IL-8、CRP和IT比值的敏感性、特异性、阳性和阴性预测值以及95%置信区间。分析受试者工作特征曲线以确定最佳阈值。在1997年6月至1998年6月期间，对疑似NBI的新生儿进行了215次IL-8检测，并根据IL-8和/或CRP值升高决定开始抗生素治疗。进行了成本效益分析，并重新评估了敏感性、特异性和受试者工作特征曲线。
在首次怀疑NBI时，IL-8≥53 pg/mL和/或CRP>10 mg/L的组合检测到经培养证实的NBI的敏感性为96%。检测到经培养证实和临床诊断的NBI的组合的敏感性为93%，特异性为80%。使用IL-8可将疑似NBI的不必要抗生素治疗减少73%，与仅基于临床体征或基于临床体征以及IT比值和/或CRP升高开始抗生素治疗相比，具有成本效益。
IL-8和/或CRP的组合是诊断新生儿NBI的可靠且早期的检测方法。使用IL-8和/或CRP的组合将抗生素治疗限制于真正感染的婴儿可减少不必要的抗生素治疗，且具有成本效益。
