Biomarkers for risk stratification and antibiotic stewardship in elderly patients

PurposeOptimal treatment of infections in the elderly patients population is challenging because clinical symptoms and signs may be less specific potentially resulting in both, over- and undertreatment. Elderly patients also have a less pronounced immune response to infection, which may influence kinetics of biomarkers of infection.MethodsWithin a group of experts, we critically reviewed the current literature regarding biomarkers for risk stratification and antibiotic stewardship in elderly patients with emphasis on procalcitonin (PCT).ResultsThe expert group agreed that there is strong evidence that the elderly patient population is particularly vulnerable for infections and due to ambiguity of clinical signs and parameters in the elderly, there is considerable risk for undertreatment. At the same time, however, this group of patients is particularly vulnerable for off-target effects from antibiotic treatment and limiting the use of antibiotics is therefore important. The use of infection markers including PCT to guide individual treatment decisions has thus particular appeal in geriatric patients. For the elderly, there is evidence that PCT is a valuable biomarker for assessing the risk of septic complications and adverse outcomes, and helpful for guiding individual decisions for or against antibiotic treatment. There is need for additional educational efforts regarding the concept of biomarker-guided antibiotic stewardship for health care providers caring for elderly patients.ConclusionUse of biomarkers, most notably PCT, has high potential to improve the antibiotic management of elderly patients with possible infection for improving both, undertreatment and overtreatment. Within this narrative review, we aim to provide evidence-based concepts for the safe and efficient use of PCT in elderly patients.

Automated summary

The optimal treatment of infections in the elderly population is challenging due to less specific clinical symptoms and signs. Elderly patients have a weaker immune response to infection and may be at risk of both over- and undertreatment. The use of biomarkers, particularly procalcitonin (PCT), has shown potential in assessing the risk of septic complications and guiding antibiotic treatment decisions in elderly patients.