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Trends in C-Reactive Protein Use in Early-onset Sepsis Evaluations and Associated Antibiotic Use
Journal article   Peer reviewed

Trends in C-Reactive Protein Use in Early-onset Sepsis Evaluations and Associated Antibiotic Use

Alvaro Zevallos Barboza, Dustin D. Flannery, Di Shu, MiKayla Galloway, Miren B. Dhudasia, Christopher P. Bonafide, William E. Benitz, Jeffrey S. Gerber and Sagori Mukhopadhyay
The Journal of pediatrics, v 273, 114153
Oct 2024
DOI: https://doi.org/10.1016/j.jpeds.2024.114153
PMID: 38901777
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

healthcare utilization neonatal sepsis sepsis biomarker
To determine the prevalence of C-reactive protein (CRP) use in early-onset sepsis (EOS) evaluations in neonatal intensive care units (NICUs) across the US over time and to determine the association between CRP use and antibiotic use. A retrospective cohort study of NICUs contributing data to Premier Healthcare Database from 2009 through 2021. EOS evaluation was defined as a blood culture charge ≤ 3 days after birth. CRP use for each NICU was calculated as the proportion of infants with a CRP test obtained ≤ 3 days after birth among those undergoing an EOS evaluation and categorized as, low (<25%); medium-low (25 to < 50%), medium-high (50 to < 75%), and high (≥75%). Outcomes included antibiotic use and mortality ≤ 7 days after birth. Among 572 NICUs, CRP use varied widely and was associated with time. The proportion of NICUs with high CRP use decreased from 2009 to 2021 (24.7% vs 17.4%, P < .001), and those with low CRP use increased (47.9% vs 64.8%, P < .001). Compared with low-use NICUs, high-use NICUs more frequently continued antibiotics > 3 days (10% vs 25%, P < .001). This association persisted in multivariable-adjusted regression analyses (adjusted risk ratio 1.95, 95%CI 1.54, 2.48). Risk of mortality was not different in high-use NICUs (adjusted risk difference −0.02%, 95%CI -0.04%, 0.0008%). CRP use in EOS evaluations varied widely across NICUs. High CRP use was associated with prolonged antibiotic therapy but not mortality ≤ 7 days after birth. Reducing routine CRP use in EOS evaluations may be a target for neonatal antibiotic stewardship efforts.

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Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
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