Pros and cons of using biomarkers versus clinical decisions in start and stop decisions for antibiotics in the critical care setting

Albrich, Werner C.; Harbarth, Stéphan Juergen

doi:10.1007/s00134-015-3978-8

Cited by 80 publications

(63 citation statements)

References 76 publications

(154 reference statements)

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“…The utility of combining multiple parameters to improve the performance of individual markers has been described previously [15][16][17][18][19]. Therefore, in the present study, we postulated that combining previously described blood biomarkers with aSAH clinical parameters might be an efficient strategy for the stratification of patients in need of prophylactic antibiotherapy.…”

Section: Introductionmentioning

confidence: 66%

Infection prediction for aneurysmal subarachnoid hemorrhage patients at hospital admission: combined panel of serum amyloid A and clinical parameters

Azurmendi¹,

Sarrafzadeh²,

Tiberti³

et al. 2017

J Transl Sci

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Purpose: Nosocomial infections are some of the main causes of worsening outcomes and death in aneurysmal subarachnoid hemorrhage patients. We hypothesize that combination of clinical parameters and blood biomarkers could increase the capacity of individual markers to dichotomize the patients at risk of infections. Methods:The present study included 104 patients (69 infected/35 non-infected) from two independent European cohorts. Accuracy of biomarkers (serum amyloid A, C-reactive protein, neopterin and WBC) and clinical parameters (WFNS, GCS and age) were evaluated at hospital admission using receiver operating characteristic curves. The most accurate panel combination was obtained using Panelomix. Results:At hospital admission, the most sensitive parameters for the stratification of patients at risk of developing an infection were SAA and the WFNS. To reach a SP of 100% (95% CI, 100-100), SE values of 26.9% (95% CI, 15.9-38.1) and 31.9% (95% CI, 21.7-43.5) were obtained respectively. Moreover, the combination of SAA, WBC, WFNS, and age significantly improved the SE to 64.3% (95% CI, 50-78.6). Conclusions:At hospital admission the panel SAA, WBC, WFNS, and age appear as a promising tool for predicting in-hospital infections, which could lead to a better management of patients and in their associated outcomes.

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Section: Introductionmentioning

confidence: 66%

Infection prediction for aneurysmal subarachnoid hemorrhage patients at hospital admission: combined panel of serum amyloid A and clinical parameters

Azurmendi¹,

Sarrafzadeh²,

Tiberti³

et al. 2017

J Transl Sci

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“…PCT is less convincing for treatment initiation or for withholding therapy initially. It is believed therefore that biomarkers should not be used alone, but in addition to microbiological information [20].…”

Section: A Magnifying Glassmentioning

confidence: 99%

Much Ado About the New Definitions of Sepsis

Copotoiu

2016

The Journal of Critical Care Medicine

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Following the publication of the new definition of sepsis (Sepsis-3), a plethora of articles have been published in medical journals. Recognizing the epidemiological importance of the previous definitions, first issued in 1992 (Sepsis-1), and subsequently revised in 2001 (Sepsis-2), the most recent opinion emphasizes the failure "to provide adequate groups of patients with homogenous aetiologies, presentations and outcomes", and blamed one of the causes "for the failure of several randomized controlled trials (RCTs), that tested the efficacy of adjuvant sepsis therapies". This review summarizes the recent advances in sepsis definition.

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“…Yet, tailoring specific antibacterial treatments to individual cases would result in better outcomes. Serum biomarkers can be monitored as an additional tool to guide antibiotic therapy, and the clinical benefits of serum biomarkers for patients with bacterial sepsis were demonstrated (6,7). A multidimensional proteomics approach was previously used to identify molecular signatures of nonhuman primates (NHPs) infected with Burkholderia mallei (8), a bacterium that is closely related to B. pseudomallei.…”

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confidence: 99%

Calprotectin as a Biomarker for Melioidosis Disease Progression and Management

et al. 2017

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Melioidosis is a neglected tropical disease that is caused by the bacterium Burkholderia pseudomallei and is underreported in many countries where the disease is endemic. A long and costly administration of antibiotics is needed to clear infections, and there is an unmet need for biomarkers to guide antibiotic treatment and increase the number of patients that complete therapy. We identified calprotectin as a lead biomarker of B. pseudomallei infections and examined correlations between this serum protein and the antibiotic treatment outcomes of patients with melioidosis. Serum levels of calprotectin and C-reactive protein were significantly higher in patients with melioidosis and nonmelioidosis sepsis than in healthy controls. Median calprotectin levels were higher in patients with melioidosis than in those with nonmelioidosis sepsis, whereas C-reactive protein levels were similar in both groups. Notably, intensive intravenous antibiotic treatment of patients with melioidosis resulted in lower levels of calprotectin and C-reactive protein (P Ͻ 0.0001), coinciding with recovery. The median percent reduction of calprotectin and C-reactive protein was 71% for both biomarkers after antibacterial therapy. In contrast, we found no significant differences in calreticulin levels between the two melioidosis treatment phases. Thus, reductions in serum calprotectin levels were linked to therapeutic responses to antibiotics. Our results suggest that calprotectin may be a sensitive indicator of melioidosis disease activity and illustrate the potential utility of this biomarker in guiding the duration of antibiotic therapy.

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Pros and cons of using biomarkers versus clinical decisions in start and stop decisions for antibiotics in the critical care setting

Cited by 80 publications

References 76 publications

Infection prediction for aneurysmal subarachnoid hemorrhage patients at hospital admission: combined panel of serum amyloid A and clinical parameters

Infection prediction for aneurysmal subarachnoid hemorrhage patients at hospital admission: combined panel of serum amyloid A and clinical parameters

Much Ado About the New Definitions of Sepsis

Calprotectin as a Biomarker for Melioidosis Disease Progression and Management

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