Numbenjapon Nawapom, Chamnanwanakij Sangkae, Sangaroon Preeyapan, Simasathien Sriluck, Watanaveeradej Veerachai
J Med Assoc Thai. 2015 Apr;98(4):352-7.
Clinical sepsis is a common diagnosis in neonate and is usually treated with antibiotic. The duration of treatment is usually more than five days or until all cultures from the patient's samples reveal negative.
To determine whether quantitative C-reactive protein (CRP) level less than 10 mg/L could be used as a reliable index for discontinuation of antibiotic treatment in Thai neonates with clinical sepsis.
All neonates with birth weight greater than 1,500 grams, diagnosed as clinical sepsis, were enrolled to the study. Serum CRP was measured at 24 to 48 hours after the first dose of antibiotics. If CRP level was less than 10 mg/L, infants were randomly divided to groups Ia and Ib. If CRP level was 10 mg/L or more, infants were randomly divided to groups IIa and IIb. Antibiotics were discontinued promptly after the CRP level was reported in group Ia, while CRP level was measured daily and antibiotics were discontinued after it returned to less than 10 mg/L in group IIa. In controlled groups (Ib and IIb), antibiotics were continued until all bacterial cultures were negative. The outcome measurements were the number ofpatients who required retreatment for clinical sepsis within three days and 28 days after discontinuing antibiotics.
Of 98 neonates with clinical sepsis, 76 (77.6%) were in group I. The duration of antibiotic treatment in group Ia was shorter than group Ib significantly, 1.68 vs. 5.47 days (p < 0.01). One neonate in group Ia was retreated on the third day after discontinuing antibiotics due to positive blood and urine cultures. The negative predictive value of CRP for discontinuation of antibiotics in group I was 97.4%. The durations of antibiotic treatments were 5.27 and 7.09 days in group IIa and IIb, respectively. One neonate in group IIa was retreated on the second day after discontinuing antibiotics since the patient's clinical and laboratory results suggested severe sepsis although all bacterial cultures were negative. No patient was readmitted for treatment of sepsis within 28 days after discontinuing antibiotics.
CRP levels were less than 10 mg/L in the majority of neonates with clinical sepsis. The negative predictive value for using this level as a guide for antibiotic discontinuation was 97.4%.
临床脓毒症是新生儿常见的诊断疾病，通常采用抗生素治疗。治疗持续时间通常超过五天，或直至患者样本的所有培养结果均显示为阴性。
确定定量C反应蛋白（CRP）水平低于10mg/L是否可作为泰国临床脓毒症新生儿停用抗生素治疗的可靠指标。
所有出生体重超过1500克、诊断为临床脓毒症的新生儿均纳入本研究。在首剂抗生素使用后24至48小时测量血清CRP。如果CRP水平低于10mg/L，婴儿被随机分为Ia组和Ib组。如果CRP水平为10mg/L或更高，婴儿被随机分为IIa组和IIb组。Ia组在报告CRP水平后立即停用抗生素，而IIa组每天测量CRP水平，在其降至低于10mg/L后停用抗生素。在对照组（Ib组和IIb组）中，抗生素持续使用直至所有细菌培养结果为阴性。观察指标为停用抗生素后三天和28天内因临床脓毒症需要再次治疗的患者数量。
98例临床脓毒症新生儿中，76例（77.6%）在I组。Ia组抗生素治疗持续时间明显短于Ib组，分别为1.68天和5.47天（p<0.01）。Ia组有1例新生儿在停用抗生素后第三天因血培养和尿培养阳性而再次接受治疗。I组中CRP用于停用抗生素的阴性预测值为97.4%。IIa组和IIb组抗生素治疗持续时间分别为5.27天和7.09天。IIa组有1例新生儿在停用抗生素后第二天再次接受治疗，因为尽管所有细菌培养结果为阴性，但患者的临床和实验室检查结果提示为严重脓毒症。停用抗生素后28天内无患者因脓毒症再次入院治疗。
大多数临床脓毒症新生儿的CRP水平低于10mg/L。将该水平作为停用抗生素的指导指标，其阴性预测值为97.4%。
