Measurement of Interleukin 8 in Combination With C-Reactive Protein Reduced Unnecessary Antibiotic Therapy in Newborn Infants: A Multicenter, Randomized, Controlled Trial

• Published in: Pediatrics (Evanston) 2004-07, Vol.114 (1), p.1-8
• Main Authors: Franz, Axel R, Bauer, Karl, Schalk, Andreas, Garland, Suzanne M, Bowman, Ellen D, Rex, Kerstin, Nyholm, Calle, Norman, Mikael, Bougatef, Adel, Kron, Martina, Mihatsch, Walter Andreas, Pohlandt, Frank, International IL-8 Study Group
• Format: Article
• Language: English
• Subjects: Algorithms; Anti-Bacterial Agents - therapeutic use; Antibiotics; Babies; Bacteria; Bacterial diseases; Bacterial infections; Bacterial Infections - blood; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Bacterial sepsis; Biological and medical sciences; C-reactive protein; C-Reactive Protein - analysis; Care and treatment; Comparative analysis; Cytokines; Diagnostic tests; General aspects; Health aspects; Human bacterial diseases; Humans; Infant mortality; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - diagnosis; Infant, Premature, Diseases - drug therapy; Infants; Infants (Newborn); Infections; Infectious diseases; Interleukin-8; Interleukin-8 - blood; Medical sciences; Medicin och hälsovetenskap; Newborn infants; Patient outcomes; Pediatrics; Proteins; Sensitivity and Specificity; Unnecessary Procedures
• ISSN: 0031-4005; 1098-4275; 1098-4275
• DOI: 10.1542/peds.114.1.1

Neonatal bacterial infections carry a high mortality when diagnosed late. Early diagnosis is difficult because initial clinical signs are nonspecific. Consequently, physicians frequently prescribe antibiotic treatment to newborn infants for fear of missing a life-threatening infection. This study was designed to test the hypotheses that a diagnostic algorithm that includes measurements of interleukin 8 (IL-8) and C-reactive protein (CRP) 1) reduces antibiotic therapy and 2) does not result in more initially missed infections compared with standard management that does not include an IL-8 measurement. Term and preterm infants who were 70 pg/mL and/or CRP was >10 mg/L (IL-8 group). The primary outcome variables were 1) the number of infants treated with antibiotics and 2) the number of infants with infections missed at the initial evaluation. In the IL-8 group, fewer infants received antibiotic therapy than in the standard group (36.1% [237 of 656] vs 49.6% [315 of 635]). In the IL-8 group, 24 (14.5%) of 165 infants with infection were not detected at the initial evaluation, compared with 28 (17.3%) of 162 in the standard group. The number of newborn infants who received postnatal antibiotic therapy can be reduced with a diagnostic algorithm that includes measurements of IL-8 and CRP. This diagnostic strategy seemed to be safe.