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Use of biomarkers to individualize antimicrobial therapy duration: a narrative review. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Scott, J., Deresinski, S. 2022

Abstract

BACKGROUND: Reducing the overuse of antimicrobials is imperative for the sake of minimizing antimicrobial-associated adverse effects, optimizing resource utilization, and curtailing the rise in multidrug-resistant organisms. Biomarkers reflect host responses to infection and may assist with minimizing unnecessary antimicrobial usage.OBJECTIVES: To review the literature pertaining to the performance of biomarkers specifically used to guide the duration of antimicrobial therapy (AMT).SOURCES: Randomized controlled trials (RCTs), observational studies, and meta-analyses assessing biomarker-guided approaches to AMT decision-making and their impact on duration of therapy were reviewed.CONTENT: Several RCTs and real-world observational studies have shown that a procalcitonin (PCT)-guided strategy can help clinicians individualize the duration of AMT, particularly for non-critically ill patients hospitalized with suspected respiratory tract infections when using a PCT cutoff of <0.25 mug/L and critically ill patients with respiratory tract infections or undifferentiated sepsis when using a PCT cutoff of <0.5 mug/L or =80% decline in peak level. C-reactive protein (CRP) is a non-specific marker of inflammation that may also assist with earlier discontinuation of AMT, though data are limited. Hematological biomarkers are prone to variance between individuals and are often influenced by medications and non-infectious conditions, making them less reliable for the purposes of AMT decision-making. Novel biomarkers, such as multi-protein signatures and host gene expression tests, have shown promise as tools to better differentiate between bacterial and non-bacterial infections; clinical studies are needed to determine whether they can be used to help optimize the duration of AMT.IMPLICATIONS: Studies have demonstrated that PCT, when utilized appropriately, can help guide clinicians to individualize and often reduce the duration of AMT, especially for patients hospitalized with respiratory tract infections and intensive care unit (ICU) patients with suspected respiratory tract infections or sepsis. The impact of utilizing other biomarkers is less clear and requires further study.

View details for DOI 10.1016/j.cmi.2022.08.026

View details for PubMedID 36096429