Foot infections in diabetes are rarely due to a single microorganism.

The purpose of this study was to investigate the frequency with which multiple organisms can be isolated from severe foot infections in diabetic patients with carefully planned techniques of collection and processing of specimens. One hundred and seventy-seven organisms were isolated from 52 patient admissions (mean 3.4 per infection) at a district hospital. This was compared to a mean of 2.1 organisms per lesion at a local university hospital and 2.3 at a smaller community hospital. Staphylococcus aureus was isolated in about half of all lesions at the three hospitals, while anaerobic organisms were isolated from 30 at the district hospital, 10 at the university hospital, and 4 at the community hospital. This study concludes that, firstly, proper techniques for collection, transportation and examination of culture specimens are important in the isolation of multiple organisms from foot infections in diabetes, and secondly, Staphylococcus aureus is often absent while anaerobic organisms are common.     

Reinfection,rather than persistent infection,in patients with chronic granulomatous disease

Chronic granulomatous disease (CGD) is characterized by severe recurrent infections with Staphylococcus aureus, certain gram-negative rods, Nocardia species, and fungi. When infections with the same species recur, they may represent relapses or new infections. We collected organisms from infections that occurred between 1992 and 2000 in patients with CGD and determined the biochemical phenotypes, in vitro antibiotic susceptibility patterns, and pulsed-field gel electrophoresis (PFGE) patterns of the organisms causing the initial and recurrent infections. Recurrence of infection with Burkholderia cepacia or Serratia marcescens was caused by a new strain in 9 of 10 cases (P=.001). Recurrent S. aureus infections were caused by new strains in 7 of 8 cases (P=.006). In patients with CGD, recurrence of infection with the same bacterial species after appropriate antibiotic therapy usually represents new infection.     

Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious endocarditis: a prospective comparative study

For one year all narcotic addicts admitted to the Detroit Medical Center with infectious endocarditis (74 cases) were compared with a control group of bacteremic addicts who had other infections (106 cases). Endocarditis was caused by Staphylococcus aureus (60.8% of cases), streptococci (16.2%), Pseudomonas aeruginosa (13.5%), mixed bacteria (8.1%), and Corynebacterium JK (1.4%). S. aureus endocarditis most frequently involved the tricuspid valve; streptococci infected left-sided valves significantly more often than other organisms (P = .001). Biventricular and multiple-valve infections were commonest in patients with pseudomonas endocarditis (P = .05). Two-dimensional echocardiography, when combined with an abnormal chest roentgenogram, was highly predictive of endocarditis. Bacteremia in the absence of endocarditis was associated with primary skin and soft tissue infection, mycotic aneurysm at the site of narcotic injection, septic arthritis, septic thrombophlebitis, pneumonia, osteomyelitis, mediastinal abscess, and unclassified infection. Polymicrobial bacteremia in the nonendocarditis group was associated with markedly increased morbidity. Mild hyponatremia occurred in 41% of all patients and was also associated with significantly increased morbidity. Analysis of the two groups disclosed similarities and differences with implications for the pathophysiology and treatment of addicts with bacteremic infection.     

Clinical features of community-acquired pneumonia treated at Srinagarind Hospital,Khon Kaen,Thailand

Pneumonia is a serious illness associated with significant morbidity and mortality. The interpretation guidelines for pneumonia management requires knowledge of both the clinical presentation of the disease and local epidemiology. We studied the clinical features, initial laboratory results, antibiotic sensitivities, and outcomes of patients diagnosed with acute community-acquired pneumonia between January 1999 and December 2000 at Srinagarind Hospital. The causative organisms were identified in only 52.2% patients; Streptococcus pneumoniae accounted for 23.1% of infections. Other common causes included Klebsiellapneumoniae (19.2%), Burkholderia pseudomallei (15.4%), Hemophilus influenzae (11.5%), Mycoplasma pneumoniae (6.2%), and Staphylococcus aureus (4.6%). Younger patients were more likely to be infected with M. pneumoniae, while the mean age of those with other types of infections was 50. Healthy adults were infected with M. pneumoniae and S. pneumoniae; specific pathogens attacked patients with certain co-morbidity : i) diabetes mellitus and ageing, ii) diabetes mellitus and renal disease, iii) cardiovascular diseases, and iv) connective tissue diseases and steroid-use; these patients were vulnerable to i) K. pneumoniae, ii) B. pseudomallei, iii) H. influenzae, and iv) S. aureus respectively. White blood cell counts were normal in M. pneumoniae infection. Gram-stained sputum had some limitations, especially when determining Gram-negative infections; chest x-rays could not differentiate pathogens. Bactermia was found in one half of patients infected with B. pseudomallei and S. aureus. Antibiotic-resistant organisms were not common in our study. Because morbidity and mortality were high among patients infected with S. aureus and B. pseudomallei, empirical antibiotic treatment should be considered in suspected cases, especially when patients present with acute severe community-acquired pneumonia.     

Multicenter surveillance study for nosocomial infections in major hospitals in Korea. Nosocomial Infection Surveillance Committee of the Korean Society for Nosocomial Infection Control

BACKGROUND: The goals of a surveillance for nosocomial infections (NIs) are to observe the magnitude and characteristics of NIs and to plan and evaluate policies and guidelines of infection control. This study was designed to determine the rate and distribution of NIs and their causative pathogens in Korean hospitals. METHODS: Prospective surveillance was performed at 15 acute care hospitals with more than 500 beds during a 3-month period from June to August 1996. The case-finding methods were laboratory-based surveillance for patients in the general wards and a direct review of medical charts done regularly for all the patients in the intensive care units. RESULTS: A total of 3162 NIs were found among 85,547 discharged patients, with an overall nosocomial infection rate of 3.70 per 100 patients discharged. Urinary tract infections constituted 30.3% of all NIs. Other infections were pneumonias, 17.2%, surgical site infections, 15.5%, and primary bloodstream infections, 14.5%. The infection rate was the highest in neurosurgery (14.21), followed by neurology (8. 62) and ontology services (6.70). The infection rate in intensive care units was higher than it was in the general wards (10.74 vs 2. 57, P =.001). The commonly isolated organisms were Staphylococcus aureus (17.2%), Pseudomonas aeruginosa (13.8%), and Escherichia coli (12.3%). CONCLUSIONS: This first multicenter surveillance study provided extensive information on the current status and trends of NIs in major hospitals in Korea. The results may contribute to the evaluation of infection control programs and the development of effective strategies in these hospitals.     

PEG site infections: the emergence of methicillin resistant Staphylococcus aureus as a major pathogen

OBJECTIVE: We reviewed the records of 126 patients who underwent PEG insertion during a 36-month period to determine the etiology of an observed increase in PEG-related infections. METHODS: Charts were reviewed to determine predictive factors of infection, the occurrence of infection, and culture results of infected sites. Insertion was performed in all cases using a standard sterile, pull-through technique. Infections were defined as having at least two of the following conditions: peristomal erythema, induration, and purulent discharge. RESULTS: PEG infections occurred in 22 patients. During the first 12-month interval, 0 of 25 patients (0%) had PEG-related infections; during the second 12-month interval, four of 37 patients (10.8%); and during the third 12-month interval, 18 of 64 patients (28.1%) (p < 0.05). Cultures from 14 of 22 peristomal infections grew methicillin resistant Staphylococcus aureus (nine), pseudomonads (three), and other organisms (two). One hundred twenty-four of 126 patients received prophylactic antibiotics or were receiving concomitant antibiotics. Of the infected patients, 21 of 22 (95.5%) received prophylaxis, and 11 of 22 (50%) were receiving concomitant antibiotics before PEG. In the noninfected group, 78 of 104 (75%) received prophylaxis, and 47 of 104 (45.2%) received concomitant antibiotics. CONCLUSIONS: Methicillin resistant Staphylococcus aureus is emerging as a major pathogen in PEG site infections. Further prospective studies are needed to establish whether current prophylactic antibiotic recommendations are adequate.     

Infections of cardiac implantable electronic devices: a retrospective multicenter observational study

Infections of cardiac implantable electronic devices (CIED) can cause significant morbidity, mortality, and financial burden. Although staphylococcal organisms account for most infections of these cardiac devices, approximately 20% of all CIED-related infections are caused by non-Staphylococcus species. Herein we describe and compare the demographics, clinical presentation, and outcomes of Staphylococcus aureus and non-staphylococcal infections of CIED.We performed a retrospective, multicenter, observational study of patients from 4 academic hospitals in Houston between 2002 and 2009. All 80 identified non-staphylococcal CIED-related infections were matched, at a 1:1 ratio, to S. aureus infections.Although the demographics and general comorbidities in the 2 study groups were relatively similar, the S. aureus group had a higher proportion of patients with coronary artery disease, diabetes mellitus, and end-stage renal disease. Additionally, 81% of S. aureus compared with only 48.5% of the non-staphylococcal CIED-related infections were health care-associated (p < 0.001). Furthermore, when compared to non-staphylococcal infections, the S. aureus group had more indwelling intravascular foreign material (p < 0.001), more rapid clinical progression (p < 0.001), and overall worse clinical presentation (p < 0.001). However, after stratifying by clinical presentation, the mortality rates in the 2 groups were similar (p = 0.45).Since approximately one-fifth of all CIED-related infections are caused by non-staphylococcal organisms, and untimely antibiotic treatment can result in serious complications, it may be prudent to broaden empiric antimicrobial therapy to cover both Gram-positive and -negative bacteria, until the causative organism is identified.     

2型糖尿病患者肺部感染病原菌特征及其与炎症因子、肺功能变化的相关性分析

目的分析2型糖尿病患者肺部感染病原菌特征及其与炎症因子、肺功能变化的相关性。方法选取2017年3月-2018年3月本院收治的2型糖尿病合并肺部感染患者(感染组)98例,同期收治的单纯性2型糖尿病患者(非感染组)92例,健康志愿者100例(对照组)。采集感染组患者的痰液标本,检测肺部感染病原菌种类及分布特征,并进行药敏试验。采集所有受试者血液标本,采用ELISA检测血清炎症因子超敏C-反应蛋白(hs-CRP)、白介素1β(IL-1β)、白介素6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,采用肺功能仪检测肺功能指标。结果98例2型糖尿病合并肺部感染患者共分离出128株病原菌,其中革兰阴性菌70株(54.69%),革兰阳性菌46株(35.94%),真菌12株(9.66%)。其中,大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌占比均>10%。大肠埃希菌对头孢噻肟、阿莫西林、红霉素的耐药率>80%,金黄色葡萄球菌对阿莫西林、红霉素的耐药率>80%,肺炎克雷伯菌对9种受试抗生素的耐药率均<80%。4组受试者比较hs-CRP、IL-1β、IL-6、TNF-α水平差异均有统计学意义(均P<0.01),其中真菌感染组hs-CRP高于其他3组(P<0.05);细菌感染组与真菌感染组比较IL-1β、IL-6、TNF-α水平差异均无统计学意义(均P>0.05),但均高于对照组和非感染组(P<0.05)。4组受试者的FEV1百分率、FEV1/FVC值及PEF水平差异均有统计学意义(均P<0.01),其中感染组上述指标均高于对照组和非感染组(均P<0.05)。结论2型糖尿病患者肺部感染的病原菌主要为革兰阴性菌,各类病原菌对常用抗菌药物均有不同程度的耐药性,且肺部病原菌感染可加重机体炎症反应,降低患者肺功能。     

Methicillin-resistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic.

AIM: To study the prevalence of pathogenic organisms and the prevalence and outcome of methicillin-resistant Staphylococcus aureus (MRSA) infection in foot ulcers in diabetic patients. METHODS: A retrospective analysis of wound swabs taken from infected foot ulcers in diabetic patients, selected from an outpatient diabetic foot clinic. Seventy-five patients (79 ulcers) with positive wound swabs were included. Size of ulcer and time to healing, in particular for MRSA-infected ulcers, were measured in all patients. RESULTS: Gram-positive aerobic bacteria were the commonest micro-organism isolated (56.7%) followed by gram-negative aerobic bacteria and anaerobes (29.8% and 13.5%, respectively). Of the gram-positive aerobes, S. aureus was found most frequently and 40% were MRSA. MRSA was isolated more commonly in patients treated with antibiotics prior to the swab compared to those who had not received antibiotics (P = 0.01). Patients whose foot ulcers were infected by MRSA had longer healing time than patients whose ulcers were infected by methicillin-sensitive S. aureus (mean (range) 35.4 (19-64) and 17.8 (8-24) weeks, respectively, P = 0.03). CONCLUSION: MRSA infection is common in diabetic foot ulcers and is associated with previous antibiotic treatment and prolonged time to healing. Further studies are required to assess the need for antibiotics in treating foot ulcers in diabetes and to assess the optimum therapeutic approach to this problem.     

Are white blood cell count, platelet count, erythrocyte sedimentation rate and C-reactive protein useful in the diagnosis of septicaemia and endocarditis?

In 851 predominantly adult patients with septicaemia or endocarditis data regarding white blood cell (WBC) count, platelet count, ESR and C-reactive protein (CRP) obtained within 3 days of admission were analyzed retrospectively. Among 232 patients with complete laboratory data none had the combination of normal ESR, negative CRP and lack of both leukocytosis and thrombocytopenia. CRP was positive (greater than 10 mg/l) in 93%, ESR was elevated (greater than 20 mm/h) in 90%, leukocytosis (WBC greater than 9 X 10(9)/l) was present in 60% and thrombocytopenia (platelets less than 150 X 10(9)/l) in 35% of the patients. Patients with pneumococcal infection had generally higher ESR and CRP values and WBC counts than patients with other infections.     

Current diagnosis of infective endocarditis

An analysis was made of 91 cases of infective endocarditis (IE) with regard to causative organisms and their sensitivities to various antibiotics, the clinical features of the disease, the laboratory test results and other items were important in establishing a diagnosis of IE. The number of cases of IE has shown a tendency to increase in recent years, particularly in the number of elderly patients, and the ratio of total cases consisting of prosthetic valve endocarditis (PVE) has shown a sharp increase. The most common causative organism is still Streptococcus viridans, but there has been an increase in the incidence of IE due to benzyl-penicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis and other fastidious organisms. The percentage of underlying diseases represented by combined valvular diseases has been increasing, while the primary known cause of the infection of IE was dental treatments. A positive value for CRP, an accelerated value for ESR, leukocytosis, anemia, a decrease in serum Fe, a positive value for RA-T, were all parameters which showed a high correlation with IE, and these should be useful in establishing the diagnosis of IE. The use of cardioechography to detect cardiac vegetation is important in relation to establishing the diagnosis and prognosis of IE, and the evaluation of the therapeutic results.     

In vitro production of panton-valentine leukocidin among strains of methicillin-resistant Staphylococcus aureus causing diverse infections.

BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus strains have recently been associated with severe necrotizing infections. Greater than 75% of these strains carry the genes for Panton-Valentine leukocidin (PVL), suggesting that this toxin may mediate these severe infections. However, to date, studies have not provided evidence of toxin production. METHODS: Twenty-nine community-acquired methicillin-resistant Staphylococcus aureus and 2 community-acquired methicillin-susceptible S. aureus strains were collected from patients with infections of varying severity. Strains were analyzed for the presence of lukF-PV and SCCmecA type. PVL production in lukF-PV gene-positive strains was measured by ELISA, and the amount produced was analyzed relative to severity of infection. RESULTS: Only 2 of the 31 strains tested, 1 methicillin-resistant Staphylococcus aureus abscess isolate and 1 nasal carriage methicillin-susceptible S. aureus isolate, were lukF-PV negative. All methicillin-resistant Staphylococcus aureus strains were SCCmec type IV. PVL was produced by all strains harboring lukF-PV, although a marked strain-to-strain variation was observed. Twenty-six (90%) of 29 strains produced 50-350 ng/mL of PVL; the remaining strains produced PVL in excess of 500 ng/mL. The quantity of PVL produced in vitro did not correlate with severity of infection. CONCLUSIONS: Although PVL likely plays an important role in the pathogenesis of these infections, its mere presence is not solely responsible for the increased severity. Factors that up-regulate toxin synthesis in vivo could contribute to more-severe disease and worse outcomes in patients with community-acquired methicillin-resistant Staphylococcus aureus infection.     

Septicaemia in a teaching hospital in Kuwait--I: Incidence and aetiology

During a period of 18 months of study, blood cultures were performed on 3845 patients in hospital with clinical signs of infection. Among these, 214 (5.6%) episodes of septicaemia were diagnosed which correspond to 10.9/1000 hospital admissions. About 80% of the episodes were due to Gram-negative organisms, most common of which were Escherichia coli (19.6%), Salmonella spp (16.5%) and Klebsiella spp (15.1%). Gram-positive organisms implicated in 20% of episodes were mainly Staphylococcus aureus (9.3%) and enterococci (4.9%). Of all the septicaemias 62.0% were community-acquired with Salmonella spp. being the organism most commonly implicated. Hospital-acquired infections were mainly due to Serratia spp, Pseudomonas spp and Flavobacterium spp. The antibiotic resistance pattern of the organisms showed that hospital-acquired organisms had relatively high resistance to most antibiotics as compared with community-acquired organisms.     

Nosocomial bloodstream infections in children and adolescents in southern Israel: a 10-year prospective study (1992-2001)

We studied the epidemiology, microbiology, clinical presentation and outcome of nosocomial bloodstream infections (NBI) in children and adolescents in southern Israel during 1992-2001. Information on NBI was collected prospectively by active surveillance. NBI was diagnosed when a clinically significant positive blood culture was drawn in a patient during >48 h after admission. 469 episodes occurred in 370 children and adolescents aged 1 m-18 y. The overall incidence of NBI was 5.3/1000 patients, with no increase during the study period. A significant decrease in NBI incidence was recorded at the neonatal intensive care unit (NICU) during 1997-2001 vs 1992-1996. The incidences of NBI at the paediatric ICU (PICU), paediatric wards and paediatric surgery departments (PSD) were 24.1, 2.8 and 2.5/1000 patients, with an increase in NBI cases at PICU and PSD during 1997-2001 vs 1992-1996. Of 661 pathogens, Gram-negative, Gram-positive and fungal organisms were isolated in 54.3%, 36.6% and 9.1% of cases, respectively. Enterobacteriaceae (34.6% of all isolates) were the most frequently isolated Gram-negative organisms. Enterococcus spp., coagulase-negative staphylococci and Staphylococcus aureus (9.5% of all isolates each) were the most frequently isolated in Gram-positive organisms. A significant increase was recorded in the incidence of NBI caused by Streptococcus pneumoniae and Pseudomonas spp. A significant decrease in the susceptibility of Enterobacteriaceae spp. to piperacillin, ceftazidime, gentamicin and ceftriaxone was recorded during the study period. 33 (8.9%) patients with NBI died.     

Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia

BACKGROUND: The restriction of vancomycin hydrochloride use is recommended as a measure to decrease the emergence of vancomycin resistance in gram-positive organisms; however, vancomycin also is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) infections. If vancomycin use is restricted to patients with documented infections due to methicillin-resistant organisms, then patients with MRSA infections may not initially receive vancomycin. This study was performed to determine factors that predict MRSA bacteremia and if ineffective empiric antibiotic therapy increased the risk of death in patients with S aureus bacteremia. METHODS: We conducted a retrospective cohort study of all patients with clinically significant S aureus bacteremia (132 episodes in 128 patients) diagnosed between October 1, 1995, and January 1, 1998, at an urban acute care Veterans Affairs medical center (approximately 200 acute care beds) in Baltimore, Md. During the study period, vancomycin was a restricted antibiotic. Empiric use had to be approved by an attending physician specializing in infectious diseases. RESULTS: Compared with patients who had methicillin-sensitive S aureus bacteremia, patients with MRSA bacteremia were significantly older (70 vs 58 years; P<.01), more likely to have a history of MRSA (47% vs 6%; P<.01) and a nosocomial infection (76% vs 50%; P<.01), and less likely to use injection drugs (8% vs 32%; P<.01). In addition, compared with patients who had methicillin-sensitive S aureus bacteremia, patients with MRSA bacteremia were significantly less likely (45% vs 98%; P<.01) to receive effective antibiotic therapy during the first 48 hours of hospitalization. However, the risk of death due to ineffective empiric therapy was less than 1 (relative risk, 0.82; 95% confidence interval, 0.36-1.88) and did not change significantly when adjusted for age, occurrence of sepsis, or nosocomial infection. CONCLUSIONS: The results of this study support the safety of the restriction of vancomycin use in patients with clinically significant S aureus bacteremia. However, patients with a history of MRSA are more likely to have future MRSA infections and should receive empiric therapy using vancomycin for possible S aureus infections, particularly for nosocomial infections.     

Prospective study of bacterial infection in acute liver failure: an analysis of fifty patients

Fifty consecutive patients admitted with acute liver failure, minimal grade II encephalopathy, were studied prospectively to determine the incidence, timing and cause of bacterial infection, the relationship to clinical criteria for infection; and the influence of early microbiological diagnosis on clinical outcome. There were 53 proven bacterial infections in 40 patients, whereas in 5 of the remaining 10 patients infection was suspected on clinical grounds in the absence of significant cultures. Seven patients (14%) had more than one bacterial infection, and four patients had simultaneous infections caused by different organisms at each site. Fourteen infections (26.4%) were associated with bacteremia, and in six of these no source was found. Twenty-five infections (47.1%) arose from the respiratory tract, 12 (22.6%) from the urinary tract and 2 (3.7%) from central venous cannulas. Thirty-seven (69.8%) of the 53 infections were due to gram-positive bacteria; Staphylococcus aureus accounted for 19 (35.8%) of all the infections. Thirty patients died (60%), 28 of whom had bacterial infection at some time; in 24 of these the infection was diagnosed less than 24 hr before death. All nine deaths that occurred more than 7 days after admission were directly attributable to microbial infection. Clinical features such as elevated temperature and elevated peripheral white blood cell count were poor indicators of bacterial infection because these were absent in 30.2% of cases. These data show that there is a high incidence of bacterial infection early in the course of acute liver failure and suggest that prophylactic antimicrobial therapy, although unproven, might be justified.     

Infectious Complications of the Peritoneovenous Shunt

The peritoneovenous shunt has been recently advocated to relieve massive ascites refractory to medical therapy. Several complications of the shunt have been described but the incidence of infection has not been elucidated. We reviewed the records of all patients undergoing peritoneovenous shunt at the Emory University Affiliated Hospitals from 1975 to 1980. Eighty-five peritoneovenous shunts were done in 56 patients. Eighteen of the shunt insertions (21%) were followed by a major infection--eight bacteremias, eight peritonitis, and nine wound infections. Most infections were caused by aerobic gram-negative bacilli or Staphylococcus aureus. Fever was common (62%) in the immediate postoperative period but was not clearly related to infection, or the administration of antibiotics or antipyretics. Shunt removal appeared to be necessary in treating bacteremic patients but not in patients with only peritonitis or wound infections. Infection is a common complication of the peritoneovenous shunt and may limit its usefulness.     

Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors.

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are not commonly recognized in healthy patients without predisposing risk. We performed a retrospective study of patients hospitalized with community-acquired MRSA infections from 1992 to 1996 in Honolulu to determine if community-acquired MRSA infections occurred in patients without known risk. Patients hospitalized within the previous 6 months or transferred from other hospitals or nursing homes were excluded. Epidemiological and clinical data were obtained from an inpatient chart review. Ten (71%) of 14 patients with community-acquired MRSA infection had no discernible characteristics of MRSA infections. Thirteen (93%) patients had skin or soft-tissue infections and one patient had MRSA pneumonia. Isolates from patients with MRSA infection were more likely to be susceptible to ciprofloxacin (P = .05), clindamycin (P = .03), and erythromycin (P = .01) than were those from MRSA-colonized patients. In our population, the majority of community-acquired MRSA infections occurred in previously healthy individuals without characteristics suggestive of MRSA transmission.     

Quantitative C-reactive protein in relation to erythrocyte sedimentation rate, fever, and duration of antimicrobial therapy in bacteraemic diseases of childhood

Forty-two unselected patients, all less than 16 years old, with a confirmed bacteraemic infection, were included in a study in which the value of nephelometrically quantified C-reactive protein (CRP) was evaluated. Twenty-two children had purulent meningitis, nine purulent arthritis, five septicaemia, four haematogenous osteomyelitis, and one cellulitis. In addition, one had septicaemia caused by mixed infection. CRP was related to the history and age of the patient, the erythrocyte sedimentation rate (ESR), the time required for defervescence, and the duration of antimicrobial therapy.CRP was almost always highest at the time of admission. In contrast, ESR measurements reached a maximum only after the patient had been several days in the ward. These findings were unaffected by age, aetiology, nature of the disease and length of the history. The overall period required for the CRP to return to normal ( 10 mg/1) was eight days and of the ESR (to 20–25 mm/h) 24 days (P < 0·001). The average time for defervescence was four days, and the mean duration of antimicrobial therapy was 16 days. The increased CRP values reflected bacteraemic diseases reliably, and recovery of the patients was reflected also in decreasing CRP values. Quantitative determination of CRP should therefore be utilised at diagnosis and during treatment and follow-up of bacterial infections. A method for quantification of CRP is described.