Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Area of Science:

• Critical care medicine
• Infectious diseases
• Clinical pharmacology

Background:

• Antimicrobial resistance is a growing global threat.
• Critically ill patients, including those with sepsis and COVID-19, often receive broad-spectrum antibiotics.
• Optimizing antimicrobial use is essential for patient outcomes and combating resistance.

Purpose of the Study:

• To review the current evidence on biomarker-guided antimicrobial treatment in critically ill adults.
• To evaluate the role of biomarkers, especially procalcitonin, in antimicrobial stewardship.
• To assess the safety and efficacy of reducing antibiotic duration based on biomarker levels.

Main Methods:

• Comprehensive literature search of randomized clinical trials and observational studies.
• Focus on adult patients with sepsis and COVID-19.
• Analysis of biomarker data, primarily procalcitonin (PCT), to guide antibiotic discontinuation.

Main Results:

• Procalcitonin (PCT) is the most studied biomarker for guiding antibiotic therapy.
• Algorithms using decreasing PCT levels have proven safe and effective in reducing antibiotic treatment duration.
• This strategy lowers antibiotic-associated adverse events and the risk of multidrug-resistant organism infections.

Conclusions:

• Biomarker-guided antimicrobial therapy, especially with PCT, should be integrated into antimicrobial stewardship programs.
• This approach is vital for reducing unnecessary antibiotic use, even in the context of COVID-19.
• Further research is needed for other biomarkers like C-reactive protein and presepsin.