Abstract
In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing in more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on. Biomarkers might provide help for decision-making and improve antibiotic management. The purpose of this expert panel review was to examine currently available literature on the potential role of biomarkers to improve antimicrobial prescribing, by answering three questions: 1) Which are the biomarkers available for this purpose?; 2) What is their potential role in the initiation of antibiotic therapy?; and 3) What is their role in the decision to stop antibiotic therapy? To answer these questions, studies reviewed were limited to recent clinical studies (<15 years), involving a substantial number of patients (>50) and restricted to controlled trials and meta-analyses for answering questions 2 and 3. With regard to the first question concerning routinely available biomarkers, which might be useful for antibiotic management of acute infections, these are currently limited to C-reactive protein (CRP) and procalcitonin (PCT). Other promising biomarkers that may prove useful in the near future but need to undergo more extensive clinical testing include sTREM-1, suPAR, ProADM, and Presepsin. New approaches to biomarkers of infections include point-of-care testing and genomics.
Highlights
Good antibiotic prescribing-which often means less prescribing-is of major concern to physicians nowadays, both because of high levels of antibiotic consumption in hospitals, and of the increasing prevalence of antimicrobial resistance, even if rates of methicillin-resistant Staphylococcus aureus have decreased recently in many European countries since the early 2000s
An 18-member expert panel convened under the auspices of the Maurice Rapin Institute, a not-for-profit independent physicians’ association, to provide a state-of-the-art assessment of the currently available biomarkers and their potential role as an aid to the management of antibiotic therapy for acute infections
To frame the appraisal of the potential clinical role of biomarkers, the panel was asked to answer three formatted questions, as follows: 1. Which are the currently available biomarkers of the host’s response, those that are routinely available and which may contribute to the management of antibiotics in acute infections, and what are the limitations to the interpretation of their results in this context?
Summary
Good antibiotic prescribing-which often means less prescribing-is of major concern to physicians nowadays, both because of high levels of antibiotic consumption in hospitals, and of the increasing prevalence of antimicrobial resistance, even if rates of methicillin-resistant Staphylococcus aureus have decreased recently in many European countries since the early 2000s.
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