This Article Full Text Full Text (PDF) An erratum has been published Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Franz, A. R. Search for Related Content PubMed PubMed Citation Articles by Franz, A. R. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

PEDIATRICS Vol. 114 No. 1 July 2004, pp. 1-8

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

Axel R. Franz, MD^*, Karl Bauer, MD, Andreas Schalk, MD, Suzanne M. Garland, MD^||, Ellen D. Bowman, MD^¶, Kerstin Rex, MD^#,*, Calle Nyholm, MD^**, Mikael Norman, MD, Adel Bougatef, MD, Martina Kron, PhD^||, Walter Andreas Mihatsch, MD^*, Frank Pohlandt, MD^* for the International IL-8 Study Group

^* Department of Pediatrics, Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
Department of Pediatrics, Free University of Berlin, University Hospital Benjamin Franklin, Berlin, Germany
Department of Pediatrics, Landeskrankenhaus Villach, Villach, Austria
^|| Department of Microbiology and Infectious Disease, Royal Women's Hospital, Women's and Children's Health, Carlton, Victoria, Australia
^¶ Department of Pediatrics, Royal Women's Hospital, Women's and Children's Health, Parkville, Victoria, Australia
^# Department of Pediatrics, Kärnsjukhuset, Skövde, Sweden
^** Department of Pediatrics, Länssjukhuset Ryhov, Jönköping, Sweden
Department of Woman and Child Health, Division of Neonatology, Karolinska Institutet and Hospital, Stockholm, Sweden
Department of Neonatology, Academic Hospital, Brussels Free University, Brussels, Belgium
^|| Department of Biometry and Medical Documentation, University of Ulm, Ulm, Germany

Objective. 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.

Methods. Term and preterm infants who were <72 hours of age and had clinical signs or obstetric risk factors suggesting neonatal bacterial infection but stable enough to wait for results of diagnostic tests were enrolled into the study. A total of 1291 infants were randomly assigned to receive antibiotic therapy according to the guidelines of each center (standard group) or to receive antibiotic therapy when IL-8 was >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.

Results. 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.

Conclusions. 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.

---

Key Words: cytokines • C-reactive protein • newborn infant • interleukin-8 • sepsis

Abbreviations: CRP, C-reactive protein • IL-8, interleukin 8 • CI, confidence interval

---

Received for publication Aug 25, 2003; Accepted Nov 13, 2003.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. R. Bentlin, L. M. S. de Souza Rugolo, A. R. Junior, M. Hashimoto, and J. C. Lyra Is Urine Interleukin-8 Level a Reliable Laboratory Test for Diagnosing Late Onset Sepsis in Premature Infants? J Trop Pediatr, December 1, 2007; 53(6): 403 - 408. [Abstract] [Full Text] [PDF]

				M. C.P. Franco, D. M.J. Christofalo, A. L. Sawaya, S. A. Ajzen, and R. Sesso Effects of Low Birth Weight in 8- to 13-Year-Old Children: Implications in Endothelial Function and Uric Acid Levels Hypertension, July 1, 2006; 48(1): 45 - 50. [Abstract] [Full Text] [PDF]

				M. B. Lande, N. L. Carson, J. Roy, and C. C. Meagher Effects of Childhood Primary Hypertension on Carotid Intima Media Thickness: A Matched Controlled Study Hypertension, July 1, 2006; 48(1): 40 - 44. [Abstract] [Full Text] [PDF]

				U K Mishra, S E Jacobs, L W Doyle, and S M Garland Newer approaches to the diagnosis of early onset neonatal sepsis. Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2006; 91(3): F208 - F212. [Abstract] [Full Text] [PDF]

				J.-H. Weitkamp and J. L. Aschner Diagnostic Use of C-Reactive Protein (CRP) in Assessment of Neonatal Sepsis NeoReviews, November 1, 2005; 6(11): e508 - e515. [Full Text] [PDF]

				K. Skogstrand, P. Thorsen, B. Norgaard-Pedersen, D. E. Schendel, L. C. Sorensen, and D. M. Hougaard Simultaneous Measurement of 25 Inflammatory Markers and Neurotrophins in Neonatal Dried Blood Spots by Immunoassay with xMAP Technology Clin. Chem., October 1, 2005; 51(10): 1854 - 1866. [Abstract] [Full Text] [PDF]