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. 2012 Jul 23;2(1):32.
doi: 10.1186/2110-5820-2-32.

Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review

Pedro Póvoa  1 , Jorge I F Salluh
Affiliations

Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review

Pedro Póvoa et al. Ann Intensive Care. .

Abstract

Biomarkers of infection, namely C-reactive protein and procalcitonin (PCT), are potentially useful in the diagnosis of infection as well as in the assessment of its response to antibiotic therapy. C-reactive protein variations overtime appears to have a good performance for the diagnosis of infection. Procalcitonin shows a better correlation with clinical severity. In addition, to overcome the worldwide problem of antibiotic overuse as well as misuse, biomarker guidance of antibiotic stewardship represents a promising new approach. In several randomized, controlled trials, including adult critically ill patients, PCT guidance was repeatedly associated with a decrease in the duration of antibiotic therapy. However, these trials present several limitations, namely high rate of patients' exclusion, high rate of algorithm overruling, long duration of antibiotic therapy in the control group, disregard the effect of renal failure on PCT level, and above all a possible higher mortality and higher late organ failure in the PCT arm. In addition, some infections (e.g., endocarditis) as well as frequent nosocomial bacteria (e.g., Pseudomonas aeruginosa) are not suitable to be assessed by PCT algorithms. Therefore, the true value of PCT-guided algorithm of antibiotic stewardship in assisting the clinical decision-making process at the bedside remains uncertain. Future studies should take into account the issues identified in the present review.

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Figures

Figure 1
Figure 1
Procalcitonin algorithm for stewardship of antibiotic therapy; adapted from [[10]].
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References

    1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. doi: 10.1097/00003246-200107000-00002. - DOI - PubMed
    1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–1554. doi: 10.1056/NEJMoa022139. - DOI - PubMed
    1. Agency for Healthcare Research and Quality. Diagnostic groups with rapidly increasing costs by payer. 2001–2007. HCUP statistical brief 91. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb91.pdf. - PubMed
    1. The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. Crit Care Resusc. 2007;9:8–18. - PubMed
    1. Povoa PR, Carneiro AH, Ribeiro OS, Pereira AC. Influence of vasopressor agent in septic shock mortality. Results from the Portuguese Community-Acquired Sepsis Study (SACiUCI study) Crit Care Med. 2009;37:410–416. doi: 10.1097/CCM.0b013e3181958b1c. - DOI - PubMed