Introduction

There is an increasing interest to individualize patient management and decisions regarding antibiotic treatment. Biomarkers may provide relevant information for this purpose.

Areas covered

Despite a growing number of clinical trials investigating several biomarkers, there remain open questions regarding the best type of biomarker, timing or frequency of testing, and optimal cutoffs among others. The most promising results in regard to diagnosis of bacterial infection and therapy monitoring are found for procalcitonin (PCT), although some recent trials were not able to validate the promising earlier findings. Furthermore, less specific markers like C-reactive protein (CRP) and new prognostic biomarkers such as proadrenomedullin (MR-proADM) may improve the prognostic assessment of patients and proteomics may help shorten time to microbiological results. The aim of this review is to summarize the current concept of biomarker-guided management and provide an outlook of promising ongoing investigations.

Expert opinion

‘Antibiotic stewardship’ is complex and needs more than just the measurement of one single biomarker. However, when integrated into the context of a thorough clinical examination, standard blood parameters and a well done risk stratification by clinical scores such as the SOFA-score, biomarkers have great potential to improve the diagnostic and prognostic assessment of patients.

中文翻译：

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生物标志物指导的抗生素治疗的价值。

介绍

人们对个性化患者管理和抗生素治疗决策的兴趣日益浓厚。生物标志物可能会为此目的提供相关信息。

覆盖区域

尽管研究多种生物标志物的临床试验数量不断增加，但在最佳生物标志物类型、测试时间或频率以及最佳截止值等方面仍然存在悬而未决的问题。在细菌感染诊断和治疗监测方面最有希望的结果是降钙素原 (PCT)，尽管最近的一些试验无法验证早期的有希望的发现。此外，C 反应蛋白 (CRP) 等特异性较低的标志物和肾上腺髓质素原 (MR-proADM) 等新的预后生物标志物可能会改善患者的预后评估，蛋白质组学可能有助于缩短获得微生物结果的时间。本综述的目的是总结生物标志物指导管理的当前概念，并提供有希望的正在进行的研究的前景。

专家意见

“抗生素管理”是复杂的，需要的不仅仅是测量一个单一的生物标志物。然而，当整合到彻底的临床检查、标准血液参数和通过临床评分（如 SOFA 评分）进行的良好风险分层的背景下时，生物标志物具有改善患者诊断和预后评估的巨大潜力。