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J Infect. 2014 Feb;68(2):149-55. doi: 10.1016/j.jinf.2013.10.006. Epub 2013 Oct 24.

Characteristics of patients with community-acquired bacteremia who have low levels of C-reactive protein (≤20 mg/L).

Author information

1
Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark. Electronic address: fredrikkeknudtzen@hotmail.com.
2
Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark.
3
Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, Entrance 101, 4th Floor, 5000 Odense C, Denmark.
4
Department of Emergency Medicine, Odense University Hospital, Kloevervaenget 25, Entrance 63-65, 5000 Odense C, Denmark.
5
Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2nd Floor, 5000 Odense C, Denmark.
6
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, Entrance 40, 5000 Odense C, Denmark.

Abstract

OBJECTIVES:

To characterize patients presenting with community-acquired bacteremia and a low C-reactive protein (CRP) plasma level at date of bacteremia.

METHODS:

Population-based cohort study. Patient characteristics were compared for three CRP groups (≤20 mg/L, 21-100 mg/L and >100 mg/L) using chi-square test and oneway anova. The 30-day mortality rates were compared using logistic regression analyses.

RESULTS:

Of the 2017 patients included, 193 (9.6%) had a CRP ≤20 mg/L. These patients were younger, more likely to be male, overrepresented in the intensive care unit and had more comorbidities. In blood cultures from the low CRP group hemolytic streptococci and coagulase-negative staphylococci were found relatively more common, whereas Streptococcus pneumoniae or Staphylococcus aureus were found relatively less common compared to the other CRP groups. The majority of patients with an initial low CRP mounted a CRP response the following days. The 30-day mortality rate was lower in the low CRP group (13.5%) than in the group with CRP >100 mg/L (20.6%).

CONCLUSIONS:

A considerable proportion of patients with community-acquired bacteremia has a normal or low initial CRP level. The plasma CRP level should not be used to rule out serious infection or withhold antibiotic therapy.

KEYWORDS:

C-reactive protein; Coagulase-negative staphylococci; Community-acquired bacteremia; Hemolytic streptococci

PMID:
24429297
DOI:
10.1016/j.jinf.2013.10.006
[Indexed for MEDLINE]
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