ABSTRACT
PURPOSE: To determine whether C-reactive protein (CRP) can be used as a parameter to assess the safety of discontinuing antibiotic therapy and allows a shorter course of therapy in neonates treated for suspected bacterial infection. METHODS: We have experienced 193 cases of suspected neonatal bacterial infection at Pusan Maryknoll Hospital. CRP levels were measured daily by immunonephelometry. Infants with initial CRP levels less than 0.8mg/dL were considered unlikely to be infected, and antibiotic therapy was stopped (group A; n=82). If three daily serial CRP levels were less than 0.8mg/dL, antibiotics were discontinued (group B; n=51). Sixty cases were treated for at least 7 days irrespective of CRP results (group C; n=60), and relapse rates of bacterial infection were compared between the three groups within one month after discharge. RESULTS: Within the one month follow-up period, two infants (2.4%) in group A, one infant (1.3%) in group B, two infants (3.3%) in group C received antibiotics for possible relapse of bacterial infection. The relapse rate in these groups was very low and frequency of a second course of antibiotic therapy between these groups was not different. CONCLUSION: These data allow considerably shorter courses of antibiotic therapy, safe discontinuation by three serial CRP measurement and show that CRP can be a key parameter for guiding the duration of antibiotic treatment. In addition, it would cut the length and cost of hospital stays and diminish the side effects of parenteral antibiotics.
Subject(s)
Humans , Infant , Infant, Newborn , Anti-Bacterial Agents , Bacterial Infections , C-Reactive Protein , Follow-Up Studies , Length of Stay , RecurrenceABSTRACT
PURPOSE: To determine whether C-reactive protein (CRP) can be used as a parameter to assess the safety of discontinuing antibiotic therapy and allows a shorter course of therapy in neonates treated for suspected bacterial infection. METHODS: We have experienced 193 cases of suspected neonatal bacterial infection at Pusan Maryknoll Hospital. CRP levels were measured daily by immunonephelometry. Infants with initial CRP levels less than 0.8mg/dL were considered unlikely to be infected, and antibiotic therapy was stopped (group A; n=82). If three daily serial CRP levels were less than 0.8mg/dL, antibiotics were discontinued (group B; n=51). Sixty cases were treated for at least 7 days irrespective of CRP results (group C; n=60), and relapse rates of bacterial infection were compared between the three groups within one month after discharge. RESULTS: Within the one month follow-up period, two infants (2.4%) in group A, one infant (1.3%) in group B, two infants (3.3%) in group C received antibiotics for possible relapse of bacterial infection. The relapse rate in these groups was very low and frequency of a second course of antibiotic therapy between these groups was not different. CONCLUSION: These data allow considerably shorter courses of antibiotic therapy, safe discontinuation by three serial CRP measurement and show that CRP can be a key parameter for guiding the duration of antibiotic treatment. In addition, it would cut the length and cost of hospital stays and diminish the side effects of parenteral antibiotics.
Subject(s)
Humans , Infant , Infant, Newborn , Anti-Bacterial Agents , Bacterial Infections , C-Reactive Protein , Follow-Up Studies , Length of Stay , RecurrenceABSTRACT
PURPOSE: Mycoplasma pneumoniae pneumonias have been one of the most common causes of lower respiratory tract diseases during childhood. It is suggested that pathologic changes seen in the lung tissues were the histologic expression of the host immune response. The aim of this study was to determine the relationship between the chest radiographic pattern of Mycoplasma pneumoniae pneumonia and the level of the cell-mediated immunity of the host. METHODS: Chest radiographic changes and the results of tuberculin skin test (5TU PPD) were studied during the acute stage of infection in 76 patients with Mycoplasma pneumoniae pneumonia. Chest radiographic findings were used to divide the patients into two groups; one group had a predominance of diffuse reticulonodular infiltration (Group A; n=40), while the remainings showed a predominance of segmental or lobar consolidation (Group B; n=36). A comparison was made between the two groups in terms of age, gender, total leukocyte and lymphocyte count, mycoplasma antibody titer, severity of pneumonia, and pleural effusion. RESULTS: Sixty out of 70 patients had negative tuberculin skin test and the positive rate of PPD reaction was higher in Group A (14/40) compared to Group B (2/40) (P0.05). CONCLUSION: Our study suggests that the cell-mediated immunity of patients with Mycoplasma pneumoniae pneumonia might influence the radiographic pattern of the pulmonary lesions.
Subject(s)
Humans , Immunity, Cellular , Leukocytes , Lung , Lymphocyte Count , Mycoplasma pneumoniae , Mycoplasma , Pleural Effusion , Pneumonia , Pneumonia, Mycoplasma , Radiography , Radiography, Thoracic , Respiratory Tract Diseases , Skin Tests , Thorax , Tuberculin , Tuberculin TestABSTRACT
BACKGROUND: A correct estimation of volume status and dry weight in dialysis patients remains a difficult clinical problem. Clinical status and chest X-ray are not sensitive enough, while invasively measured central venous pressures are not routinely available. Recently, the ultrasonographic determination of the diameter and collapse index of the inferior vena cava has been proposed as a noninvasive method for estimating intravascular volume. We tried to evaluate the clinical relevance of this method in dialysis patients by comparing it with alphahuman-atrial natriuretic peptide (alpha-h-ANP) and cyclic guanosine 3:5-monophosphate (cGMP) levels. METHODS: Using echocardiography, the diameter of the inferior vena cava (VCD) and its decrease on deep inspiration (collapse index : CI) were evaluated in 27 hemodialysis patients. Echocardiography of the inferior vena cava (IVC) was performed in the supine position after 10 minutes rest. The transducer was placed in the subxiphoid region and long and short axis views of the IVC were obtained just below the diaphragm in the hepatic segment. VCD was measured before the P-wave on the electrocardiogram to avoid interference with A-wave and V-wave on the venous pressure curve, and corrected for body surface area. Preand post-hemodialysis levels of the plasma alpha-h-ANP and cGMP were measured by radioimmunoassay. The relationship between VCD, CI determined by echocardiography, and alpha-h-ANP and cGMP concentrations were studied. RESULTS: The levels of alpha-h-ANP and cGMP were markedly elevated before hemodialysis and significantly lower values were found after hemodialysis (alpha-hANP : 162.7 102.6 pg/ml vs 90.6 61.0 pg/ml , cGMP : 35.3 8.8 pmol/ml vs 21.3 6.2 pmol/ml). A significant correlation was found between VCD and alpha-h-ANP before (r=0.81, p 0.05) and also no relation was observed between the decrease of cGMP during hemodialysis and VCD before hemodialysis (r=0.12, p > 0.05). A significant correlation between the percent change in body weight and the percent change in VCD during hemodialysis (r=0.91, p<0.05) and also significant relation was observed between the pecent change in body weight and the percent change in alpha-h-ANP levels (r=0.40, p , 0.05). CONCLUSION: Echocardiography of the inferior vena cava allow an estimation of changes of intravascular volume in ESRDpatients without cardiac filling impairment as shown by the correlation to other indices of intravascular volume, such as alpha-h-ANP. In this study, CI and cGMP levels were less informative. Inferior vena cava echocardiography is noninvasive and easily available and serial measurements of VCD and alphah-ANP levels allow an estimation of chages of intravascular volume in ESRD patients on maintenance hemodialysis.
Subject(s)
Humans , Axis, Cervical Vertebra , Body Surface Area , Body Weight , Central Venous Pressure , Dialysis , Diaphragm , Echocardiography , Electrocardiography , Guanosine , Kidney Failure, Chronic , Plasma , Radioimmunoassay , Renal Dialysis , Supine Position , Thorax , Transducers , Vena Cava, Inferior , Venous PressureABSTRACT
No abstract available.