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Review
. 2022 Mar 9;11(3):367.
doi: 10.3390/antibiotics11030367.

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Evdoxia Kyriazopoulou  1 , Evangelos J Giamarellos-Bourboulis  2
Affiliations
Review

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Evdoxia Kyriazopoulou et al. Antibiotics (Basel). .

Abstract

This review aims to summarize current progress in the management of critically ill, using biomarkers as guidance for antimicrobial treatment with a focus on antimicrobial stewardship. Accumulated evidence from randomized clinical trials (RCTs) and observational studies in adults for the biomarker-guided antimicrobial treatment of critically ill (mainly sepsis and COVID-19 patients) has been extensively searched and is provided. Procalcitonin (PCT) is the best studied biomarker; in the majority of randomized clinical trials an algorithm of discontinuation of antibiotics with decreasing PCT over serial measurements has been proven safe and effective to reduce length of antimicrobial treatment, antibiotic-associated adverse events and long-term infectious complications like infections by multidrug-resistant organisms and Clostridioides difficile. Other biomarkers, such as C-reactive protein and presepsin, are already being tested as guidance for shorter antimicrobial treatment, but more research is needed. Current evidence suggests that biomarkers, mainly procalcitonin, should be implemented in antimicrobial stewardship programs even in the COVID-19 era, when, although bacterial coinfection rate is low, antimicrobial overconsumption remains high.

Keywords: C-reactive protein; COVID-19; ICU; antimicrobial stewardship; biomarker; guided antimicrobial therapy; infection; presepsin; procalcitonin; sepsis.

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Conflict of interest statement

E.J.G.-B. has received honoraria from Abbott CH, bioMérieux, Brahms GmbH, GSK, InflaRx GmbH, Sobi and XBiotech Inc; independent educational grants from Abbott CH, AxisShield, bioMérieux Inc, InflaRx GmbH, Johnson & Johnson, MSD, Sobi and XBiotech Inc.; and funding from the Horizon2020 Marie-Curie Project European Sepsis Academy (granted to the National and Kapodistrian University of Athens), and the Horizon 2020 European Grants ImmunoSep and RISCinCOVID (granted to the Hellenic Institute for the Study of Sepsis). E.K. reports no conflicts of interest.

Figures

Figure 1
Figure 1
Study selection.
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