Biomarkers as a guide for antimicrobial therapy.
The use of biomarkers might help to avoid antibiotic misuse and overuse and to curb the rising incidence of microbial resistance. Amongst >100 biomarkers proposed for use as infection/sepsis markers, procalcitonin is the most frequently evaluated. It has been tested in 11 randomised controlled trials with more than 3500 patients and resulted in a considerable 35-70% reduction in antibiotic use without an apparent negative impact on patient outcome. Testing was carried out in hospital, Intensive Care Unit, emergency and primary care settings; most of the patients had lower respiratory tract infections and only smaller studies exist in surgical patients with infectious complications, immunocompromised patients and patients with sepsis. There are, however, concerns - trials designed to show non-inferiority of procalcitonin to standard management allowed rather large differences for mortality rates, in the range of 7.5-10%, thus clinically relevant excess mortality by procalcitonin-guided antibiotic therapy cannot be completely ruled out. Marker panels derived from transcriptomic or proteomic profiling hold promise in overcoming the limitations of procalcitonin for differentiating non-infectious from infection-associated inflammation. However, the utility of these novel diagnostic tools in the clinical setting remains to be proven.
Department of Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, Jena, Germany. konrad.reinhart@med.uni-jena.de
Konrad
K
Reinhart
Christiane S
CS
Hartog
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002986:Clinical Trials as Topic; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide