Related Experiment Video
Updated: Aug 14, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Factors Associated with Antibiotic Initiation After DaBT-Hib-IPV Vaccination in NICU-Hospitalized Preterm Infants:
Hüseyin Şimşek1, Mustafa Akçalı1, Mehtap Durukan Tosun1
1Neonatology Department, Mersin City Training and Research Hospital, 33240 Mersin, Türkiye.
Insights
Post-vaccination C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) elevations were linked to antibiotic use in hospitalized infants after the DaBT-Hib-IPV vaccine. These markers may not reliably distinguish infection from vaccine inflammation, necessitating clinical correlation.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Vaccinology
Background:
- Hospitalized infants, particularly those in Neonatal Intensive Care Units (NICUs), often receive the 2-month diphtheria-acellular pertussis-tetanus-Haemophilus influenzae Type B-inactivated poliovirus (DaBT-Hib-IPV) vaccine.
- Decisions regarding antibiotic administration in these infants can be complex, influenced by various clinical and laboratory factors.
- Post-vaccination inflammatory responses, indicated by biomarkers like C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), may complicate the differentiation between true infection and vaccine-induced reactions.
Purpose of the Study:
- To evaluate the association between post-vaccination C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) and the clinical decision to initiate antibiotic treatment.
- To investigate factors influencing antibiotic administration in hospitalized infants following the 2-month DaBT-Hib-IPV vaccination.
Main Methods:
- Retrospective review of medical records for 46 hospitalized infants who received the 2-month DaBT-Hib-IPV vaccine.
- Categorization of infants based on antibiotic treatment initiation post-vaccination.
- Analysis of laboratory markers, including CRP and NLR, alongside clinical data such as gestational age and weight at vaccination.
Main Results:
- Antibiotic treatment was administered to 20 infants; 26 were managed without antibiotics.
- Infants receiving antibiotics had significantly longer hospital stays (median 99 vs. 78 days) and higher post-vaccination CRP (2.82 vs. 1.63 mg/dL) and NLR (0.90 vs. 0.72).
- C-reactive protein (CRP) emerged as the sole independent predictor of antibiotic administration (Exp(B) = 3.997, p = 0.003), even after adjusting for gestational age and weight.
Conclusions:
- Elevated post-vaccination CRP and NLR were associated with antibiotic initiation in NICU-hospitalized infants, a population not representative of general 2-month-old infants.
- These inflammatory markers alone cannot reliably distinguish between true infection and vaccine-induced inflammation in the absence of a validated infection reference standard.
- Clinical findings, culture results, and supplementary biomarkers should be integrated with CRP and NLR to guide antibiotic decisions and prevent unnecessary use.
Abstract:
Objective: The purpose of this study was to evaluate the factors, particularly post-vaccination C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR), associated with the clinical decision to initiate antibiotic treatment following the 2-month diphtheria-acellular pertussis-tetanus-Haemophilus influenzae Type B-inactivated poliovirus (DaBT-Hib-IPV) vaccine in hospitalized infants. Methods: A retrospective review was conducted on the medical records of 46 infants. The study included infants hospitalized between 2022 and 2024 at Mersin City Training and Research Hospital who received the 2-month vaccine and subsequently underwent post-vaccination laboratory testing. Infants were categorized based on whether they received antibiotic treatment. Results: Antibiotics were administered to 20 infants, and 26 were observed without any treatment. Despite having a significantly higher gestational age (p = 0.027), the hospital stays of the antibiotic group were significantly longer (median 99 vs. 78 days, p < 0.001). C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were elevated in the antibiotic group (CRP = 2.82 vs. 1.63 mg/dL, p < 0.001; NLR= 0.90 vs. 0.72, p = 0.041). Culture positivity was low in antibiotic recipients (3/20, 15%). CRP was the only independent predictor of antibiotic administration when adjusted for gestational age and weight at vaccination (Exp(B) = 3.997, p = 0.003). Conclusions: In this cohort of NICU-hospitalized, predominantly preterm infants, a population that does not represent the general population of vaccinated 2-month-old infants, post-vaccination elevations in CRP and NLRs were associated with the clinical decision to initiate antibiotic treatment; however, in the absence of a validated infection reference standard, these markers cannot be assumed to reliably differentiate true infection from vaccine-induced inflammation. To prevent unnecessary antibiotic use and optimize patient management, these markers must be evaluated in conjunction with clinical findings, culture results, and supplementary biomarkers.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...
01:29Respiratory Syncytial Virus Disease
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Pneumonia III: Complications and Assessment
01:21Microbiota Modulation by Antibiotics
01:25Clinical Significance of Antibiotic Resistance