Usefulness of the C-Reactive Protein in Predicting the Need for Antibiotics Among Febrile Inpatients with Sickle Cell Disease

Objective: To determine whether the C-reactive protein (CRP) can help identify which febrile patients with sickle cell disease (SCD) require antibiotic therapy. Patients and Methods: We performed a chart review of patients with SCD (including S-S, S-C, and S-Thal) admitted to the hospital with fever [temperature >38.3C <2 years of age; >38.9C ≥2 years of age] over a thirty-month period (July 2009 – December 2011). Data extracted included temperature, age, high sensitivity CRP value, chest x-ray and culture results, and the underlying cause of fever, categorized as bacterial (antibiotics necessary) or non-bacterial (antibiotics not necessary). The Mann-Whitney U-test was then used to compare the median CRP levels of patients requiring antibiotics versus those whose illnesses did not require antibiotic treatment. Results: Fifty-four febrile patients with SCD were admitted to the hospital. Nineteen had final diagnoses that required antibiotic treatment and their median CRPs were significantly higher than the thirty-five who had diagnoses that did not meet the requirements for antibiotic treatment (100.9 mg/L vs 17.3 mg/L, p <.001). All patients who needed antibiotics had a CRP >39 mg/L. Conclusion: The current data indicate that among febrile patients with SCD, the CRP may help differentiate bacterial infections which require antibiotic treatment from other diseases for which antibiotics are not necessary. Our data suggests that there may be a level of CRP below which a bacterial etiology is unlikely.