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Epidemiology
Research
Use of C-reactive protein to tailor antibiotic use: a systematic review and meta-analysis
  1. Dara Petel1,
  2. Nicholas Winters2,
  3. Genevieve C Gore3,
  4. Jesse Papenburg4,5,
  5. Marc Beltempo6,
  6. Jacques Lacroix7,
  7. Patricia S Fontela5,8
  1. 1 Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
  2. 2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  3. 3 Schulich Library of Physical Sciences, Life Sciences and Engineering, Montreal, Canada
  4. 4 Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
  5. 5 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  6. 6 Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
  7. 7 Division of Pediatric Critical Care, Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
  8. 8 Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Patricia S Fontela; patricia.fontela{at}mcgill.ca

Abstract

Background and objectives C-reactive protein (CRP) has been proposed to guide the use of antibiotics. However, study results are controversial regarding the benefits of such a strategy. We synthesised the evidence of CRP-based algorithms on antibiotic treatment initiation and on antibiotic treatment duration in adults, children and neonates, as well as their safety profile.

Design Systematic review and meta-analysis.

Data sources MEDLINE, EMBASE, CENTRAL and CINAHL from inception to 20 July 2017.

Eligibility criteria for selecting studies We included randomised controlled trials (RCTs), non-RCTs and cohort studies (prospective or retrospective) investigating CRP-guided antibiotic use in adults, children and neonates with bacterial infection.

Data extraction and synthesis Two researchers independently screened all identified studies and retrieved the data. Outcomes were duration of antibiotic use, antibiotic initiation, mortality, infection relapse and hospitalisation. We assessed the quality of the included studies using the Cochrane Collaboration’s tool (RCTs), and A Cochrane Risk Of Bias Assessment Tool: for Non-Randomized Studies of Interventions and the Newcastle-Ottawa scale (non-RCTs). We analysed our results using descriptive statistics and random effects models.

Results Of 11 165 studies screened, 15 were included. In five RCTs in adult outpatients, the risk difference for antibiotic treatment initiation in the CRP group was −7% (95% CI: −10% to –4%), with no difference in hospitalisation rate. In neonates, CRP-based algorithms shortened antibiotic treatment duration by −1.45 days (95% CI −2.61 to –0.28) in two RCTs, and by −1.15 days (95% CI −2.06 to –0.24) in two cohort studies, with no differences in mortality or infection relapse.

Conclusion The use of CRP-based algorithms seems to reduce antibiotic treatment duration in neonates, as well as to decrease antibiotic treatment initiation in adult outpatients. However, further high-quality studies are still needed to assess safety, particularly in children outside the neonatal period.

PROSPERO registration number CRD42016038622

  • c-reactive protein
  • antibiotics
  • bacterial infection
  • test
  • child
  • adult

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022133

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors All authors have made significant contributions to the study conception and design, article revision and have given final approval for the submitted version. The specific contributions of each author are the following: DP: study design and conduct, development of search strategy, data collection, data analysis, manuscript writing. NW: study design and conduct, data analysis, manuscript writing. GCG: development of search strategy, conduct of electronic database search. JP, MB and JL: study design, data analysis, manuscript review. PSF (guarantor): study design and conduct, development of search strategy, data analysis, manuscript writing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JP reports personal fees or research grant funding from BD Diagnostic Systems, Cepheid, AbbVie and RPS Diagnostics outside the submitted work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data were collected from previously published research. Our dataset is available on request from the corresponding author.