Abstract
BackgroundThe aim of the present study was to evaluate the C-reactive protein level, the body temperature and the white cell count in patients after prescription of antibiotics in order to describe the clinical resolution of severe community-acquired pneumonia.MethodsA cohort of 53 consecutive patients with severe community-acquired pneumonia was studied. The C-reactive protein levels, body temperature and white cell count were monitored daily.ResultsBy day 3 a C-reactive protein level 0.5 times the initial level was a marker of poor outcome (sensitivity, 0.91; specificity, 0.59). Patients were divided according to their C-reactive protein patterns of response to antibiotics, into fast response, slow response, nonresponse, and biphasic response. About 96% of patients with a C-reactive protein pattern of fast response and 74% of patients with a slow response pattern survived, whereas those patients with the patterns of nonresponse and of biphasic response had a mortality rate of 100% and 33%, respectively (P < 0.001). On day 3 of antibiotic therapy, a decrease in C-reactive protein levels by 0.31 or more from the previous day's level was a marker of good prognosis (sensitivity, 0.75; specificity, 0.85).ConclusionDaily C-reactive protein measurement after antibiotic prescription is useful in identification, as early as day 3, of severe community-acquired pneumonia patients with poor outcome. The identification of the C-reactive protein pattern of response to antibiotic therapy was useful in the recognition of the individual clinical course, either improving or worsening, as well as the rate of improvement, in patients with severe community-acquired pneumonia.
Highlights
Community-acquired pneumonia (CAP) remains a common and serious illness, with an estimated incidence of 2–12 cases/1,000 population per year [1]
Patients were divided according to their C-reactive protein patterns of response to antibiotics, into fast response, slow response, nonresponse, and biphasic response
Daily C-reactive protein measurement after antibiotic prescription is useful in identification, as early as day 3, of severe community-acquired pneumonia patients with poor outcome
Summary
Community-acquired pneumonia (CAP) remains a common and serious illness, with an estimated incidence of 2–12 cases/1,000 population per year [1]. Treatment failure may be wrongly presumed when radiologic infiltrates are resolving slowly but the patient has a superimposed problem, such as drug fever, malignancy, inflammatory conditions, heart failure, or a hospital-acquired infection from another source [3]. In such clinical situations, it is very difficult to identify the cause of the presumed treatment failure, since clinical and radiological evaluation is insufficient to differentiate an infectious complication from a noninfectious complication. The aim of the present study was to evaluate the C-reactive protein level, the body temperature and the white cell count in patients after prescription of antibiotics in order to describe the clinical resolution of severe community-acquired pneumonia
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