Biomarker research regarding antibiotic stewardship

Main investigator of a large antibiotic stewardship trial using the biomarker procalcitonin (PCT) and several subsequent individual patient data meta-analyses to understand safety of early stopping antibiotics based on biomarker kinetics. This research on antibiotic stewardship has led to several high impact publications and inclusion of recommendations in different international guidelines.

For the last 10 years we conducted research to better understand the clinical value of biomarkers for the purpose of antibiotic stewardship starting with several trials done in Switzerland lead by our group (i.e., “ProHOSP trial”, JAMA, 2009, Sep 9;302(10):1059-66) and “PARTI trial” Arch Intern Med. 2008 Oct 13;168(18):2000-7). These trials found strong reductions in antibiotic use particularly for patients with respiratory infections including pneumonia, COPD exacerbation and bronchitis. We also looked at other types of infection such as Legionella, heart failure with superinfection, patients with post-operative fever, patient with positive cultures for coagulase-negative staphylococci among others. To better understand safety of using PCT for antibiotic stewardship, it is important to study large numbers of patients. We thus pooled available trial data in ineividual patient data meta-analysis in collaboration with Cochrane and our international network of researchers participating in previous stewardship trials. In the most recent update published in 2018 (Lancet Infect Dis. 2018 Jan;18(1):95-107 and Cochrane Database Syst Rev. 2017 Oct 12;10(10):CD007498), our analysis included 6708 patients from 26 eligible trials in 12 countries showed a reduction in mortality when PCT was used for antibiotic stewardship efforts. These effects were paralleled with lower antibiotic consumptions and lower risk of antibiotic side effects. Based on this database, we have also published several studies focusing on best use of PCT in different patient populations including patients with positive blood cultures (Clin Infect Dis. 2019 Jul 18;69(3):388-396), ICU patients with sepsis (Crit Care. 2018 Aug 15;22(1):191.), outpatients (Ann Emerg Med. 2018 Aug;72(2):226-228) among others. Together with international expert we currently further advance the field of biomarker research in infectious disease also focusing on safe and efficient implementation of PCT in clinical routine.