Objective:

To describe serial CRP changes during antibiotic treatment of paediatric VP shunt infections and assess whether CRP monitoring may inform treatment duration.

Approach:

• Design and setting: Retrospective study at Inkosi Albert Luthuli Central Hospital using records from January 2018 to December 2024.
• Participants and measures: Included 147 children with shunt-related meningitis. Researchers extracted clinical and laboratory data, including serial CRP; CRP below 10 mg/L was defined as normal.
• Analysis: CRP changes were assessed using complete-case comparisons. Additional analyses considered skewed distributions, including Wilcoxon signed-rank testing and log-transformed CRP.

Key Findings:

• Mean admission CRP was 41.4 mg/L; 48% of children had CRP above 10 mg/L.
• Mean CRP declined from 48.6 mg/L at admission to 29.4 mg/L on day 30. The complete-case paired comparison was significant (p=0.02), while the Wilcoxon signed-rank test was not; log-transformed analysis showed a significant decline.
• Twenty-five children (17%) died. Symptom duration of 7–30 days was associated with mortality (p=0.05), and age over 12 years was associated with increased mortality risk (OR=8; 95% CI not specified in the provided context).
• Antibiotic resistance was reported in 58.6% of cultured organisms; biofilm-forming bacteria included Staphylococcus epidermidis and Staphylococcus aureus.

Interpretation:

CRP decreased during treatment, but skewness, outliers, and incomplete follow-up warrant caution in interpreting the size and significance of the change. The authors state that CRP monitoring may support decisions about antibiotic duration.

Limitations:

• Retrospective design and variable follow-up.
• Organism heterogeneity and variable resistance patterns.
• CRP trajectories were not stratified by shunt externalisation or revision, or EVD placement, so changes could not be attributed to antibiotics alone.
• The admission-to-day-30 comparison did not model repeated measures or account for missingness.

Conclusion:

The authors call for further research on CRP-guided treatment and comparison of CRP with WCC and procalcitonin in paediatric VP shunt infections.

Sources:

• Article context provided by the user