Publication: Sensitivity of C-reactive protein for the identification of patients with laboratory-confirmed bacterial infections in northern Tanzania
Issued Date
2019-01-01
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ISSN
13653156
13602276
13602276
Other identifier(s)
2-s2.0-85077892842
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Mahidol University
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SCOPUS
Bibliographic Citation
Tropical Medicine and International Health. (2019)
Suggested Citation
Thomas Althaus, Yoel Lubell, Venance P. Maro, Blandina T. Mmbaga, Bingileki Lwezaula, Christine Halleux, Holly M. Biggs, Renee L. Galloway, Robyn A. Stoddard, Jamie L. Perniciaro, William L. Nicholson, Kelly Doyle, Piero Olliaro, John A. Crump, Matthew P. Rubach Sensitivity of C-reactive protein for the identification of patients with laboratory-confirmed bacterial infections in northern Tanzania. Tropical Medicine and International Health. (2019). doi:10.1111/tmi.13358 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/51168
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Title
Sensitivity of C-reactive protein for the identification of patients with laboratory-confirmed bacterial infections in northern Tanzania
Other Contributor(s)
Duke-NUS Medical School Singapore
Kilimanjaro Christian Medical Centre
Organisation Mondiale de la Santé
Intermountain Healthcare
University of Oxford
Centers for Disease Control and Prevention
University of Otago
Mahidol University
Viral and Rickettsial Zoonoses Br.
Duke University
Mawenzi Regional Referral Hospital
Kilimanjaro Christian Medical University College
Kilimanjaro Christian Medical Centre
Organisation Mondiale de la Santé
Intermountain Healthcare
University of Oxford
Centers for Disease Control and Prevention
University of Otago
Mahidol University
Viral and Rickettsial Zoonoses Br.
Duke University
Mawenzi Regional Referral Hospital
Kilimanjaro Christian Medical University College
Abstract
© 2019 John Wiley & Sons Ltd Objective: Identifying febrile patients requiring antibacterial treatment is challenging, particularly in low-resource settings. In South-East Asia, C-reactive protein (CRP) has been demonstrated to be highly sensitive and moderately specific in detecting bacterial infections and to safely reduce unnecessary antibacterial prescriptions in primary care. As evidence is scant in sub-Saharan Africa, we assessed the sensitivity of CRP in identifying serious bacterial infections in Tanzania. Methods: Samples were obtained from inpatients and outpatients in a prospective febrile illness study at two hospitals in Moshi, Tanzania, 2011–2014. Bacterial bloodstream infections (BSI) were established by blood culture, and bacterial zoonotic infections were defined by ≥4 fold rise in antibody titre between acute and convalescent sera. The sensitivity of CRP in identifying bacterial infections was estimated using thresholds of 10, 20 and 40 mg/l. Specificity was not assessed because determining false-positive CRP results was limited by the lack of diagnostic testing to confirm non-bacterial aetiologies and because ascertaining true-negative cases was limited by the imperfect sensitivity of the diagnostic tests used to identify bacterial infections. Results: Among 235 febrile outpatients and 569 febrile inpatients evaluated, 31 (3.9%) had a bacterial BSI and 61 (7.6%) had a bacterial zoonosis. Median (interquartile range) CRP values were 173 (80–315) mg/l in bacterial BSI, and 108 (31–208) mg/l in bacterial zoonoses. The sensitivity (95% confidence intervals) of CRP was 97% (83%–99%), 94% (79%–98%) and 90% (74%–97%) for identifying bacterial BSI, and 87% (76%–93%), 82% (71%–90%) and 72% (60%–82%) for bacterial zoonoses, using thresholds of 10, 20 and 40 mg/l, respectively. Conclusion: C-reactive protein was moderately sensitive for bacterial zoonoses and highly sensitive for identifying BSIs. Based on these results, operational studies are warranted to assess the safety and clinical utility of CRP for the management of non-malaria febrile illness at first-level health facilities in sub-Saharan Africa.