Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities

Pharmacotherapy. 2018 Feb;38(2):271-283. doi: 10.1002/phar.2069. Epub 2018 Jan 16.


As antimicrobial stewardship increasingly receives worldwide attention for improving patient care by optimizing antimicrobial therapy, programs are evaluating new tools that may augment antimicrobial stewardship activities. Biomarkers are objective, accurate, and reproducible measures that provide information about medical conditions. A systematic literature search using PubMed/MEDLINE databases was performed to evaluate the use of novel biomarkers as additions to the antimicrobial stewardship armamentarium. Procalcitonin may help clinicians discriminate between bacterial and viral infections, help with antimicrobial discontinuation decisions, and predict mortality. β-d-glucan, Candida albicans germ tube antibody, and galactomannan are useful in suspected fungal infections and may reduce inappropriate antifungal use. Adrenomedullin and soluble triggering receptor on myeloid cells-1 may be useful for mortality prediction and the determination of a need for empiric antibacterials. Although studies evaluating these biomarkers are promising, these biomarkers are not without limitations and should be used in combination with clinical signs, symptoms, or other biomarkers. For successful implementation of biomarker use, stewardship programs should consider the populations most likely to benefit, without using them indiscriminately in all patients. Antimicrobial stewardship programs should facilitate education of clinicians through institutional guidelines to ensure the appropriate use and interpretation of these biomarkers.

Keywords: C-reactive protein; bacterial infections; diagnostic criteria; galactomannan; infectious diseases; procalcitonin.

Publication types

  • Evaluation Study
  • Review

MeSH terms

  • Anti-Bacterial Agents / standards
  • Anti-Bacterial Agents / therapeutic use*
  • Antifungal Agents / standards
  • Antifungal Agents / therapeutic use*
  • Antimicrobial Stewardship / methods*
  • Antimicrobial Stewardship / standards
  • Biomarkers / blood
  • Galactose / analogs & derivatives
  • Humans
  • Mannans / blood
  • Procalcitonin / blood


  • Anti-Bacterial Agents
  • Antifungal Agents
  • Biomarkers
  • Mannans
  • Procalcitonin
  • galactomannan
  • Galactose