FEVER, C-REACTIVE PROTEIN, AND OTHER ACUTE-PHASE REACTANTS DURING TREATMENT OF INFECTIVE ENDOCARDITIS

Background: Fever and sustained elevations of levels of C-reactive pro tein, erythrocyte sedimentation rate, and other inflammatory markers a re common problems during treatment of infective endocarditis. We stud ied the value of these measurements during an 8-year period in all epi sodes of infective endocarditis treated in 1 university-affiliated ins titution. Methods: A total of 193 consecutive episodes that fulfilled the criteria for infective endocarditis were prospectively enrolled du ring 2 periods, 1984 through 1988 and 1993 through 1995. Fever and res ults of serial measurements of C-reactive protein, erythrocyte sedimen tation rate, white blood cell counts, and platelet counts were related to the clinical course of infective endocarditis.Results: Fever persi sted or recurred in 108 episodes (57%) despite appropriate antibiotic treatment. The causes of persistent fever and recurrent fever were dif ferent. Persistent fever that lasted 7 days or longer was caused by a complicating cardiac infection in 56% of these episodes. Recurrent fev er, noted in 31% of all episodes and the major cause of fever during t he third and fourth treatment weeks, was caused most often by hypersen sitivity reactions to beta-lactams. Elevations in C-reactive protein l evels were significantly prolonged in the episodes with complicated co urses compared with the episodes with uncomplicated courses, while mea n erythrocyte sedimentation rate remained unchanged during treatment, not differentiating between complicated and uncomplicated episodes. Co nclusions: Fever during treatment must be analyzed in terms of persist ence and recurrence to provide a basis for clinical decisions. Serial measurements of C-reactive protein are useful to monitor the reponse t o antimicrobial therapy and to detect complications, while serial dete rminations of erythrocyte sedimentation rate are of no value.