C-reactive protein: a tool in the follow-up of nosocomial pneumonia

The aim of this study was to examine the clinical usefulness of serial C-reactive protein (CRP) dosages in patients with nosocomial pneumonia (NP).

Prospective and observational study performed in a 24-beds Intensive Care Unit. Sixty four patients with NP, including non-ventilated patients and those with ventilator-associated pneumonia were included. Daily measurements of CRP were performed and CRP ratios were calculated from the day of antibiotic prescription (D0) until day 10. Patients were than classified according to the CRP ratios in 2 groups: 'good' response (CRP ratios lower than 0.67 at day 10) and 'poor' response (non-response or bi-phasic response).

The poor response group (n = 34) had a mortality rate of 53% in comparison to 20% in the good response group (n = 30) (RR = 2.65; 95% CI, 1.21-5.79, p = 0.01). Significant differences between the two groups were found on CRP ratios at Day 4 (p = 0.01). The adequacy of antibiotic therapy was much lower in the group poor response in comparison to the group good response, 14% vs. 67% (p = 0.008), respectively.

Daily CRP measurements in patients with nosocomial pneumonia may be useful in the identification of patients with poor outcome, as early as day 4, and detect patients with inappropriate antimicrobial therapy.