Cost-effectiveness of serial C-reactive protein (CRP) measurements in hospitalized patients with bacteremia

Abstract Background: CRP is increasingly used as inflammatory marker in sepsis. Aim of study: Assessment of the cost-effectiveness of CRP in the treatment of patients with bacteremia. Methods: This was a retrospective study of two patient cohorts, one in 2015 (cohort A) and the other in 2018 (cohort B), each included 200 consecutively diagnosed patients with proven bacteremia. We assessed the following outcome markers: antibiotic use, duration of admission and in-hospital mortality. Results: Baseline demographic and clinical data of the cohorts were similar. In cohort A, a single CRP test was obtained from 5% of the patients, while in cohort B, 95% of patients had CRP tests with a mean of 5.7 tests/person. Empiric, appropriate antibiotic treatment, increased from 72% in cohort A to 75% in cohort B (NS). Duration of antibiotic treatment did not change (10±8 days). The in-hospital mortality rate decreased from 38.5% in cohort A to 30.5% in cohort B (NS), as did mortality <7 days after diagnosis of bacteremia, from 17.5% to 14% respectively)(NS). Conclusion: We found statistically insignificant differences between the cohorts. It is difficult to establish a causal relationship between the described changes and the widespread use of serial CRP tests. There is currently no evidence that supports serial use of CRP tests in the treatment of patients with bacteremia.