Crp Elevation Associated with a Positive Blood Culture in Infants Participating in the Neonin Surveillance Network

METHODS: We extracted data from neonIN, a multicenter web-based surveillance database for culture proven neonatal infections. 1397 episodes were analyzed between January 2011 and April 2014.

RESULTS: Overall patients had a median gestational-age of 27 (25-31) weeks and median birth-weight 910 (685-1535) g. 828 (59.3%) were male and the median postnatal-age at infection was 13 (7-28) days. MaxCRP elevation within 48hrs of positive blood culture was higher when Gram-negative bacteria were isolated compared to either Gram-positive bacteria (p<0.001) or fungi (p<0.001) (Table1, Figure1). Spearman's rank-order correlation coefficients calculated from the overall sample for CRP elevation and postnatal-age (rho=0.2495,p=0.000), birth-weight (rho=0.0412,p=0.1260) and gestational-age (rho=0.0698,p=0.095) show no significant correlations. The same analysis was done within the subsets of Gram-positive bacteria, Gram-negative bacteria, fungi and also by specific pathogen without significant correlation.

CONCLUSIONS: Gram-negative pathogens are more likely to cause higher peak CRP elevation in neonates compared to Gram-positive pathogens. We identified no significant correlation between peak CRP responses and gestational-age or birth-weight or postnatal-age.

Figure 1. maxCRP within 48 hours of positive blood culture by type of pathogen.

Table 1. Median and IQR of max CRP (mg/L) within 48hrs of positive blood culture by type of pathogen and gestational age.

† p<0.001 compared to Gram-, after Bonferroni correction for multiple comparisons, GA:gestational-age