Strep pneumonia crp levels not going down

[rs12]

Hi all,

my dad was admitted into hospital on Monday with strep pneumonia. His CRP levels were 530 when he first came in, 413 on Tuesday, 311 yesterday but 312 today. He’s on iv antibiotics/fluids but I’m beside myself thinking that the infection isn’t going and why this marker hasn’t come down. Anyone got any idea what’s going on?

Hi,

I’m not medically trained BUT have experience here from when my Dad had Sepsis.

It looks as if his CRP has made great inwards down; have you got his WBC readings too?

I would not be so worried about his CRP at this stage, more the chance of Sepsis developing.

Have they completed blood cultures?

CRP is a protein that is synthesised as a reaction to inflammation. Because it’s a protein, that process of synthesis takes 2-3 days, so you’ll often find that CRP levels will lag behind what is happening clinically. It’s not at all uncommon for them to still be elevated for longer than you’d think, and take time to come back down. As PP mentioned, his white cell count will be a more immediate view of what is happening, but beyond blood results it’s most important to look at how your dad is doing clinically. Is he still having temperatures? Are his blood pressure and heart rate nice and stable? Is he starting to feel a bit better in himself, become more alert, is he managing to eat and drink? At this stage those things will give far more of an idea of how he’s recovering than a single blood marker can. If he’s not improving clinically the team may need to look at what antibiotics he is getting and potentially make some adjustments, but it sounds like he’s been really poorly and sometimes it just takes time and patience before you see an improvement. I hope he’s feeling better soon, try and look after yourself too in the meantime

Thanks for the quick reply.

I’ve attached his WBC count. What do you think They seem to be going up. They have done blood cultures and I will ask if they are changing antibiotics because of it.

when your dad had sepsis what were the numbers?

now attached wbc count

Thanks @SomethingDifferentBloomed . I’m more concerned that they were coming down by 100 everyday but didn’t over the last 24 hours….

No worries.

if I recall, they got to 36 for WBC, and his CRP hit 365.

it can be a rollercoaster for sure, I would 100% ask the question ‘could it be sepsis’; the Sepsis Trust is a great website and support group should that be required, but your Dads numbers are improving in the whole.

as the PP mentioned, it is so much about how they are in themselves, if you feel things are not getting the attention they deserve, escalate as you see fit; I’d always rather be a pain on this side of a problem than ask why I didn’t make a fuss.

what are his oxygen saturation levels like? Is he being given oxygen at this stage?

what about BP and are they giving fluids?

What antibiotics is he on? My son had sepsis caused by strep, his crp was 120 which is deadly for a preemie newborn. I’d be making sure they give two antibiotics to double attacks, say co amox and azith together

@clarityseeker wow those are high numbers. Do you know if my dads wbc are ok?

he’s not on oxygen thankfully. He was off that Tuesday morning. His oxygen levels are also ok, 96+ and no temp for the last two days 🙏🏽

It's very unlikely that the microbiologists haven't been involved already and the will likely be reviewing the antimicrobials, probably daily, if he's still an inpatient. The blood results need interpreting in the context of the whole picture, including his past medical history, medications, examination findings, observations - no one on here can really comment on what's going on. (DOI FWIW am a doctor)

They were high for sure and he has made a full recovery, even though he has AKI (acute kidney injury) mainstay other things that he did recover from.

i say this as not medically trained, but they don’t jump out as terrible and largely have been around range anyway.

i would keep close the the care team and don’t be afraid to ask questions to them.

ill keep you all in my thoughts and prayers and do keep us updated; I’m sure you’ll be sharing good news in no time at all

Hi all they changed my dad’s antibiotics last Friday to vancomycin. His crp levels were dropping slowly since then but started to increase a little from Tuesday. They are still 234! Should I be worried?

His wbc has been coming down and is now within range. Doctors are not too worried so long as wbc is down and he isn’t spiking temps - all obs seem normal! Help please

I had similar last year and my CRP was 600, I was discharged home after three days on just over 300 with daily visits for IV antibiotics for a few days
followed by oral antibiotics and blood tests . I have no idea how quickly the levels came down after that I’m afraid .

Thanks @jessycake. Wow those are super high levels. Did you have daily blood tests and did the crp show a steady fall? Or is that not a concern?

CRP is really not the be all and end all. It's a non-specific marker of inflammation which is helpful in association with a bunch of other parameters, and there's often a lag between clinical improvement (or deterioration) and CRP changing. Daily bloods just to get a CRP would not usually be advised if the clinical picture is improving, but for someone who's on vanc, if you're in the UK, am still pretty sure there's going to be daily microbiology input behind the scenes, weighing up the pros and cons of carrying on vs doing a bunch more tests vs tweaking antimicrobials again.

I went to hospital by ambulance on a blue light and they did say I had some spectacular blood results but I had no idea what a normal level was and only knew it had halved when I was sent home for what they called hospital at home .I did have to take my blood pressure and temperature. 3 times a day and record it with equipment they supplied for a few days, but I was never told any other figure for CRP so have no idea the rate it came down. I presume if your temperature goes up and blood pressure goes down again they would be concerned .