Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou, Evdoxia; Giamarellos‐Bourboulis, Evangelos J.

doi:10.3390/antibiotics11030367

Cited by 20 publications

(15 citation statements)

References 100 publications

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“…[IQR 8. [5][6][7][8][9][10][11] in PCT and 10 [IQR 8 -11] in control groups. At day 5, there was no difference between groups in the proportion of active antimicrobial treatment (67% PCT vs. 81% control; p = 0.24).…”

Section: Prospective Trials Without Reduction In Antimicrobial Dot-pr...mentioning

confidence: 99%

“…C-reactive protein, critical illness, pneumonia, procalcitonin, sepsis patients with infection, and some have focused on accumulating evidence in critically ill patients. [6][7][8] Despite this, a thorough analysis of biomarker application specifically relating to different types of critically ill patients has yet to be described. 6 With respect to biomarkers, this review will focus on clinical diversity within critically ill populations, the extent to which this has been accounted for in primary literature, and subsequent considerations for using biomarkers in the critically ill infected patient.…”

Section: Introductionmentioning

confidence: 99%

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Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

et al. 2023

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Managing the critically ill patient with infection is complex, requiring clinicians to synthesize considerable information relating to antimicrobial efficacy and treatment duration. The use of biomarkers may play an important role in identifying variation in treatment response and providing information about treatment efficacy. Though a vast number of biomarkers for clinical application have been described, procalcitonin and C‐reactive protein (CRP) are the most thoroughly investigated in the critically ill. However, the presence of heterogeneous populations, variable end points, and incongruent methodology in the literature complicates the use of such biomarkers to guide antimicrobial therapy. This review focuses on an appraisal of evidence for use of procalcitonin and CRP to optimize antimicrobial duration of therapy (DOT) in critically ill patients. Procalcitonin‐guided antimicrobial therapy in mixed critically ill populations with varying degrees of sepsis appears to be safe and might assist in reducing antimicrobial DOT. Compared to procalcitonin, fewer studies exist examining the impact of CRP on antimicrobial DOT and clinical outcomes in the critically ill. Procalcitonin and CRP have been insufficiently studied in many key intensive care unit populations, including surgical patients with concomitant trauma, renally insufficient populations, the immunocompromised, and patients with septic shock. We believe the available evidence is not strong enough to warrant routine use of procalcitonin or CRP to guide antimicrobial DOT in critically ill patients with infection. So long as its limitations are recognized, procalcitonin could be considered to tailor antimicrobial DOT on a case‐by‐case basis in the critically ill patient.

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Section: Prospective Trials Without Reduction In Antimicrobial Dot-pr...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

et al. 2023

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“…Catheter-associated UTIs were the most common type (55.5%) and bacterial coinfections were predominantly determined by E. coli and Enterococcus faecalis [39]. Despite low rates of bacterial coinfection, antibiotic overtreatment is still high and currently, there are no unified antibiotic stewardship programs during the ongoing pandemic COVID-19 [40,41].…”

Section: Casementioning

confidence: 99%

Possible scenarios of the development of antibiotic resistance in patients with urinary tract infection after the COVID-19 pandemic era

Krakhotkin¹,

Chernylovskyi²,

Greco³

et al. 2022

UTJ

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An outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative pathogen for COVID-19 was reported at the end of December 2019 in Wuhan, Hubei province, China, and by March 2020, it was declared a pandemic COVID-19. In hospital and critical care department settings, the majority of patients with COVID-19 receive broad-spectrum antibiotics for treatment of secondary infection complications. In patients affected by COVID-19, who had a suspected secondary bacterial superinfection, antibiotics including teicoplanin, clarithromycin, doxycycline, azithromycin, tetracyclines, levofloxacin, moxifloxacin, ciprofloxacin, and cephalosporins 3d generation were proposed as an effective treatment. In this editorial, we will consider possible scenarios of the development of antibiotic resistance after the pandemic COVID-19 in patients with urinary tract infection (UTI).

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“…Despite the recent revision of the definition of sepsis, diagnosis is still challenging for clinicians, in particular in the identification of patients at early stages (5). Alongside the diagnostic question, also important is the need to have early prognostic indications allowing clinicians to activate the most appropriate therapies based on the mortality risk of each individual patient (2,(6)(7)(8)(9)(10). A recent review collected 5367 studies identifying 258 different biomarkers of sepsis with potential diagnostic and/or prognostic functions (11).…”

Section: Introductionmentioning

confidence: 99%

A cytokine/PTX3 prognostic index as a predictor of mortality in sepsis

et al. 2022

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Background: Early prognostic stratification of patients with sepsis is a difficult clinical challenge. Aim of this study was to evaluate novel molecules in association with clinical parameters as predictors of 90-days mortality in patients admitted with sepsis at Humanitas Research Hospital.Methods: Plasma samples were collected from 178 patients, diagnosed based on Sepsis-3 criteria, at admission to the Emergency Department and after 5 days of hospitalization. Levels of pentraxin 3 (PTX3), soluble IL-1 type 2 receptor (sIL-1R2), and of a panel of pro-and anti-inflammatory cytokines were measured by ELISA. Cox proportional-hazard models were used to evaluate predictors of 90-days mortality.

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Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Cited by 20 publications

References 100 publications

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

Possible scenarios of the development of antibiotic resistance in patients with urinary tract infection after the COVID-19 pandemic era

A cytokine/PTX3 prognostic index as a predictor of mortality in sepsis

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