The value of biomarker-guided antibiotic therapy

ABSTRACT

Introduction

There is an increasing interest to individualize patient management and decisions regarding antibiotic treatment. Biomarkers may provide relevant information for this purpose.

Areas covered

Despite a growing number of clinical trials investigating several biomarkers, there remain open questions regarding the best type of biomarker, timing or frequency of testing, and optimal cutoffs among others. The most promising results in regard to diagnosis of bacterial infection and therapy monitoring are found for procalcitonin (PCT), although some recent trials were not able to validate the promising earlier findings. Furthermore, less specific markers like C-reactive protein (CRP) and new prognostic biomarkers such as proadrenomedullin (MR-proADM) may improve the prognostic assessment of patients and proteomics may help shorten time to microbiological results. The aim of this review is to summarize the current concept of biomarker-guided management and provide an outlook of promising ongoing investigations.

Expert opinion

‘Antibiotic stewardship’ is complex and needs more than just the measurement of one single biomarker. However, when integrated into the context of a thorough clinical examination, standard blood parameters and a well done risk stratification by clinical scores such as the SOFA-score, biomarkers have great potential to improve the diagnostic and prognostic assessment of patients.

KEYWORDS:

• Antibiotic stewardship
• biomarker
• procalcitonin
• CRP
• proadrenomedullin
• proteomics

Article highlights

• Biomarker-guided antibiotic treatment is a promising approach to individualize treatment to patients’ true needs and thereby reduce unnecessary initiation and prolonged courses of antibiotics.

• Procalcitonin has been shown to effectively reduce antibiotic exposure and improve clinical outcomes, but there are some remaining limitations of this concept with regard to low protocol adherence, improvements in routine care, and insufficient data in some patient populations.

• There is a growing number of novel markers and techniques that might further advance the field with improved prognostic and diagnostic information.

Declaration of interest

The authors’ institute received research support in the past from different biomarker companies including ROCHE diagnostics, bioMerieux, and Thermofisher. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer declarations

One peer reviewer is an employee and stockholder of a company working on biomarkers for infections. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.