Biomarker-Guided Antibiotic Stewardship in Acute Respiratory Infection - A Review

Abstract

Background: Antimicrobial over use in clinical setting is largely due to uncertainty in differentiating bacterial and viral infections. We have reviewed the potential role of serum biomarkers; C-Reactive Protein(CRP), Procalcitonin(PCT), Myxovirus Resistance Proteins (Myx A) and Tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) in differentiating Viral from Bacterial respiratory Infections and to guide antimicrobial stewardship practices.
Main body: In an outpatient setting, decision on empirical therapy is based on diagnostic suspicion of pulmonary infection. Atleast 2-3 days is required for routine culture results and molecular test detection lack sensitivity to distinguish between infecting pathogens and colonizing organisms in acute respiratory infection. The prognostic role of blood and respiratory secretion biomarkers, has been analyzed with variable results with data on procalcitonin guided strategies used by clinicians to guide antibiotic discontinuation after clinical stabilization in critically ill patients.
Methods: A comprehensive literature search was performed to identify studies on the role of serum biomarkers in differentiating acute bacterial and viral respiratory tract infection and relevant articles were selected after thorough screening of the articles.
Conclusion:C-reactive protein and Procalcitonin show inadequate specificity to discriminate between viral and bacterial etiology of respiratory infection. Combination of TRAIL, with CRP displayed the highest diagnostic accuracy for discriminating respiratory pathogens of bacterial and viral etiologies. Combination of C-Reactive Protein or Procalcitonin with MxA will assist to detect viral infection in patients and greatly enhance antibiotic stewardship.