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Life sciences · Journal article
BMC Infectious Diseases · October 20, 2026
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Abstract Background Inappropriate antibiotic therapy poses a significant health risk, contributing to antibiotic resistance, unfavourable prognosis, and escalated hospitalization costs. We investigated early C-reactive protein (CRP) dynamics following empiric antibiotic therapy in hospitalized patients with bacteremia, aiming to evaluate whether CRP dynamics are associated with antibiotic therapy appropriateness. Methods This retrospective cohort study comprised 122 adult patients, admitted to the emergency department in Tel Aviv Sourasky Medical Center, Israel. Participants included in the study had initial CRP levels < 31.9 mg/L and a second CRP measurement ( CRP2 ) within 24 h of the first ( CRP1 ), with subsequent microbiologically confirmed bacteremia. CRP velocity ( CRPv ) was defined as the difference between CRP2 and CRP1 ( ΔCRP ) divided by the time difference between the measurements. The cohort was categorized into Appropriate ( n = 82) and Discordant ( n = 22) groups based on antimicrobial susceptibility testing and review by infectious disease specialists, and a No-Ab-Treatment group ( n = 18) consisting of patients who did not receive antibiotics between CRP1 and CRP2; the latter two groups were combined into an Inappropriate group ( n = 40) for the primary analysis. CRP dynamics variables ( CRP2, ΔCRP and CRPv ) were compared between the groups. The performance of CRP dynamics variables as classifiers of antibiotic appropriateness was estimated using the area under the receiver operating characteristic curve (ROC-AUC). Results CRP2, ΔCRP and CRPv were similar between the Discordant and No-Ab-Treatment groups, while their levels were significantly higher in the Appropriate group. CRPv discriminated between the Appropriate and Discordant groups with ROC-AUC of 0.74 (95% CI 0.63–0.85), similar to CRP2 and ΔCRP (0.74, 95% CI 0.62–0.85; 0.75 95% CI 0.63–0.86). Conclusions Early CRP dynamics following empiric antibiotic therapy were associated with antibiotic therapy appropriateness and may represent a potential adjunctive biomarker, although validation in larger prospective cohorts is required. Trial registration Clinical trial number: not applicable.