Muller_EU_Infectious.qxp 24/1/08 9:38 am Page 106
Bacterial Infections
situations highly sensitive PCT assays are required, as subtle changes of As in most infections a true gold standard does not exist, physicians
PCT at very low concentrations can be monitored, increasing sensitivity must remain sceptical towards all published observational studies. The
and the safety of patients. In a recent study, PCT demonstrated an higher the absolute risk of a patient, the more cautious physicians
excellent discriminatory ability to identify those patients with bacterial must be, and empirical therapies must be considered despite low
arthritis in a cohort of patients with arthritis when a very low cut-off biomarker levels. Still, measurement of biomarkers, particularly highly
was applied.
49
sensitive PCT measurements embedded in a clearly defined setting and
prospectively validated with clinical algorithms, can significantly
Summary improve the diagnostic certainty and reduce the utilisation of
The limitations of clinical signs and current microbial techniques for antimicrobial therapy.
the diagnosis of bacterial infections are manifold. The use of
biomarkers provides a novel, complementary approach to diagnosing Today, this concept has been proved for LRTI and, in a pilot study, for
infection and estimating its severity and treatment response. A critical meningitis.
50
For almost all other infections, only observational studies
appraisal of the advantages and limitations of a biomarker in different have been conducted. For these clinical situations, disease and setting-
clinical situations is mandatory. Interpretation of a biomarker level specific cut-off ranges must be validated and proposed and
must always comprise the clinical setting and the assay characteristics, interventional studies conducted to tackle the existing vicious cycle of
particularly the setting-specific cut-off ranges. diagnostic uncertainty, AB overuse and emerging multiresistance. ■
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106 EUROPEAN INFECTIOUS DISEASE 2007
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