Clinical Scorecard: C-reactive Protein Changes During Antibiotic Treatment of Ventriculoperitoneal Shunt Infections in Children: A Retrospective Study

At a Glance

Key Highlights

• Mean admission CRP was 41.4 mg/L; 48% of children had admission CRP above 10 mg/L.
• Mean CRP increased to 49.4 mg/L by day 5; reported mean CRP declined from 48.6 to 29.4 mg/L between admission and day 30.
• A complete-case paired comparison found a difference in CRP between admission and day 30 (p=0.02). The Wilcoxon signed-rank test was not statistically significant, while log-transformed analysis showed a significant decline.
• Twenty-five children (17%) died; symptom duration of 7–30 days was reported to predict mortality (p=0.05). Age over 12 years was statistically associated with increased mortality risk (OR=8; the source does not provide the confidence interval).
• Antibiotic resistance was present in 58.6% of cultured organisms; reported biofilm-forming bacteria included Staphylococcus epidermidis and Staphylococcus aureus.

Guideline-Based Recommendations

Diagnosis

Management

• The authors state that CRP monitoring may support decisions about antibiotic duration, but the study does not establish a treatment-duration protocol.
• The authors recommend prioritising early shunt revision and prolonged postoperative care for biofilm or resistant infections; this is an author recommendation, not a guideline established by the study.

Monitoring & Follow-up

• The authors recommend routine CRP monitoring, particularly for patients with high-risk organisms; this is a recommendation for future work, not an evaluated monitoring protocol.
• Interpret CRP trajectories cautiously: distributions were right-skewed with outliers, follow-up was variable, and the admission-to-day-30 comparison did not model repeated measures or account for missingness.

Risks

Patient & Prescribing Data

Children with VP shunt-related meningitis; 147 patients met inclusion criteria, including 76 infants (51.7%).

Clinician-determined treatment durations were consistent with a mean antibiotic course of 27 days. The study did not establish an optimal antibiotic duration; CRP-guided treatment requires further study.

Clinical Best Practices

• The authors discuss serial CRP measurements during treatment; interpret values in light of skewness, outliers, and variable follow-up.
• The authors identify age, interval relative to shunt insertion, and underlying hydrocephalus aetiology as factors influencing CRP fluctuations.
• The authors recommend early shunt revision and prolonged postoperative care for biofilm or resistant infections; this recommendation was not tested as a comparative intervention in the study.
• The authors identify comparison of CRP, white blood cell count, and procalcitonin for identifying paediatric VP shunt infections as an area for further study.

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