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Review
. 2023 May;35(5):925-935.
doi: 10.1007/s40520-023-02388-w. Epub 2023 Mar 30.

Biomarkers for risk stratification and antibiotic stewardship in elderly patients

Marco Falcone  1 , Michael Bauer  2 , Ricard Ferrer  3 , Gaëtan Gavazzi  4 , Juan Gonzalez Del Castillo  5 , Alberto Pilotto  6   7 , Philipp Schuetz  8
Affiliations
Review

Biomarkers for risk stratification and antibiotic stewardship in elderly patients

Marco Falcone et al. Aging Clin Exp Res. 2023 May.

Abstract

Purpose: Optimal treatment of infections in the elderly patients population is challenging because clinical symptoms and signs may be less specific potentially resulting in both, over- and undertreatment. Elderly patients also have a less pronounced immune response to infection, which may influence kinetics of biomarkers of infection.

Methods: Within a group of experts, we critically reviewed the current literature regarding biomarkers for risk stratification and antibiotic stewardship in elderly patients with emphasis on procalcitonin (PCT).

Results: The expert group agreed that there is strong evidence that the elderly patient population is particularly vulnerable for infections and due to ambiguity of clinical signs and parameters in the elderly, there is considerable risk for undertreatment. At the same time, however, this group of patients is particularly vulnerable for off-target effects from antibiotic treatment and limiting the use of antibiotics is therefore important. The use of infection markers including PCT to guide individual treatment decisions has thus particular appeal in geriatric patients. For the elderly, there is evidence that PCT is a valuable biomarker for assessing the risk of septic complications and adverse outcomes, and helpful for guiding individual decisions for or against antibiotic treatment. There is need for additional educational efforts regarding the concept of "biomarker-guided antibiotic stewardship" for health care providers caring for elderly patients.

Conclusion: Use of biomarkers, most notably PCT, has high potential to improve the antibiotic management of elderly patients with possible infection for improving both, undertreatment and overtreatment. Within this narrative review, we aim to provide evidence-based concepts for the safe and efficient use of PCT in elderly patients.

Keywords: Antibiotic stewardship; Elderly; Geriatrics; Infection; Procalcitonin.

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Conflict of interest statement

This work was support by Thermofisher. The Institution of PS has previously received unrestricted grant money unrelated to this project from Nestle Health Science, Abbott Nutrition, Thermofisher and bioMérieux. RF reports personal fees Inotrem, Shionogi, Pfizer, MSD, Thermofisher, Menarini, Cytosorb, all outside the submitted work. JGC received research and educational grants from Gilead, GSK, MSD, Pfizer, and Thermofisher. MB holds shares of SmartDyeLivery GmbH, Jena. He has received funding for scientific advisory boards, travel and speaker honoraria by T2 Biosystems, Inc., La Jolla Pharmaceutical Company, SNIPR BIOME Denmark, CytoSorbents GmbH, Thermo Fisher Scientific (BRAHMS GmbH), Roche Diagnostics International Ltd., Transgene S.A., and sphingotec GmbH. These activities are not related to the current project. MF received speaker honoraria and research grants from MSD, Pfizer, Shionogi, Menarini, Thermo Fisher, Gilead.

Figures

Fig. 1
Fig. 1
Proposed PCT Algorithm for use in elderly patients mild or severe respiratory infection
See this image and copyright information in PMC

References

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