Division of Pediatric Critical Care, Department of Pediatrics.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University.
Curr Opin Infect Dis. 2018 Aug;31(4):347-352. doi: 10.1097/QCO.0000000000000467.
We aim to review recent literature about the use of biomarkers to guide the initiation and duration of antibiotic treatments for suspected bacterial infections.
Several good quality meta-analyses show that procalcitonin can be safely used to guide antibiotic-related decisions, especially for respiratory infections, thereby decreasing unnecessary antibiotic exposure. Furthermore, the use of CRP-based algorithms to guide antibiotic initiation in primary care patients with acute respiratory infections is associated with a reduction in antibiotic use without an increase in adverse events. Regarding neutrophil CD64 and serum amyloid A, more good-quality evidence is needed to assess their utility as biomarkers to tailor antibiotic use. Finally, transcriptomics, metabolomics and proteomics are promising tools for the development of tests to differentiate specific host responses to viral, bacterial and noninfectious stimuli, but such tests still need further validation.
Evidence shows that the use of biomarkers, procalcitonin and CRP, can safely reduce unnecessary antibiotic prescriptions in certain infectious syndromes. The clinical utility of host-based strategies such as transcriptomics, metabolomics and proteomics for the diagnosis of infectious diseases has yet to be evaluated, as well as considerations such as costs, technical complexity and result turnaround time.
我们旨在回顾近期有关生物标志物在指导疑似细菌感染抗生素治疗开始和持续时间中的应用的文献。
几项高质量的荟萃分析表明，降钙素原可安全用于指导抗生素相关决策，特别是用于呼吸道感染，从而减少不必要的抗生素暴露。此外，在初级保健中使用基于 CRP 的算法来指导急性呼吸道感染患者的抗生素初始治疗与减少抗生素使用而不增加不良事件相关。至于中性粒细胞 CD64 和血清淀粉样蛋白 A，需要更多高质量的证据来评估它们作为生物标志物用于调整抗生素使用的效用。最后，转录组学、代谢组学和蛋白质组学是开发用于区分特定宿主对病毒、细菌和非传染性刺激物反应的测试的有前途的工具，但这些测试仍需要进一步验证。
证据表明，使用生物标志物（降钙素原和 CRP）可安全减少某些感染综合征中不必要的抗生素处方。基于宿主的策略（如转录组学、代谢组学和蛋白质组学）用于诊断传染病的临床效用尚未得到评估，还需要考虑成本、技术复杂性和结果周转时间等因素。
