Document Detail


Measurement of interleukin 8 in combination with C-reactive protein reduced unnecessary antibiotic therapy in newborn infants: a multicenter, randomized, controlled trial.
MedLine Citation:
PMID:  15231900     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Neonatal bacterial infections carry a high mortality when diagnosed late. Early diagnosis is difficult because initial clinical signs are nonspecific. Consequently, physicians frequently prescribe antibiotic treatment to newborn infants for fear of missing a life-threatening infection. This study was designed to test the hypotheses that a diagnostic algorithm that includes measurements of interleukin 8 (IL-8) and C-reactive protein (CRP) 1) reduces antibiotic therapy and 2) does not result in more initially missed infections compared with standard management that does not include an IL-8 measurement. METHODS: Term and preterm infants who were <72 hours of age and had clinical signs or obstetric risk factors suggesting neonatal bacterial infection but stable enough to wait for results of diagnostic tests were enrolled into the study. A total of 1291 infants were randomly assigned to receive antibiotic therapy according to the guidelines of each center (standard group) or to receive antibiotic therapy when IL-8 was >70 pg/mL and/or CRP was >10 mg/L (IL-8 group). The primary outcome variables were 1) the number of infants treated with antibiotics and 2) the number of infants with infections missed at the initial evaluation. RESULTS: In the IL-8 group, fewer infants received antibiotic therapy than in the standard group (36.1% [237 of 656] vs 49.6% [315 of 635]). In the IL-8 group, 24 (14.5%) of 165 infants with infection were not detected at the initial evaluation, compared with 28 (17.3%) of 162 in the standard group. CONCLUSIONS: The number of newborn infants who received postnatal antibiotic therapy can be reduced with a diagnostic algorithm that includes measurements of IL-8 and CRP. This diagnostic strategy seemed to be safe.
Authors:
Axel R Franz; Karl Bauer; Andreas Schalk; Suzanne M Garland; Ellen D Bowman; Kerstin Rex; Calle Nyholm; Mikael Norman; Adel Bougatef; Martina Kron; Walter Andreas Mihatsch; Frank Pohlandt;
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  114     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-02     Completed Date:  2004-09-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany. axel.franz@ukb.uni-bonn.de
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Anti-Bacterial Agents / therapeutic use*
Bacterial Infections / blood,  diagnosis*,  drug therapy
C-Reactive Protein / analysis*
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / diagnosis,  drug therapy
Interleukin-8 / blood*
Sensitivity and Specificity
Unnecessary Procedures
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Interleukin-8; 9007-41-4/C-Reactive Protein
Comments/Corrections
Erratum In:
Pediatrics. 2004 Dec;114(6):1746

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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