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Biomarker im Management pulmonaler Infektionen

Biomarkers in the management of pulmonary infections

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Ein wesentliches Problem im Management von pulmonalen Infektionen ist, dass klinische Symptome wie Husten, Auswurf, Fieber und Dyspnoe nicht spezifisch sind für eine exakte Diagnose „respiratorische Infektion“ und vor allem nicht für die Notwendigkeit einer antibiotischen Therapie. Ein idealer Biomarker für bakterielle pulmonale Infektionen sollte eine frühzeitige Diagnose ermöglichen, einen prognostischen Wert haben und therapeutische Entscheidungen erleichtern. Die beiden klinisch verwendeten Biomarker sind das C-reaktive Protein (CRP) und das Procalcitonin (PCT). Das CRP ist sehr unspezifisch und sowohl bei bakteriellen und viralen Infektionen erhöht. PCT ist aktuell der einzige Biomarker, der für bakterielle pulmonale Infektionen spezifisch genug ist. In mehreren Interventionsstudien konnte nachgewiesen werden, dass durch eine PCT-Steuerung Häufigkeit und Dauer einer antibiotischen Therapie signifikant reduziert werden können bei gleicher klinischer Heilungsrate.

Abstract

A problem in the management of pulmonary infections is the low specificity of clinical symptoms such as cough, sputum, fever, and dyspnea for the exact diagnosis of “respiratory infection” and the need for antibiotic therapy. An ideal biomarker for bacterial pulmonary infections should allow rapid diagnosis, have prognostic value, and facilitate therapeutic decision making. The two biomarkers in actual clinical use are C-reactive protein (CRP) and procalcitonin (PCT). CRP is quite unspecific and may be elevated in bacterial as well as in viral infections. Today, PCT is the only biomarker specific enough for pulmonary infections. In several interventional studies, PCT-guided therapy has been shown to allow a significant reduction in the frequency and duration of antibiotic therapy, with a clinical cure rate comparable to that of standard therapy.

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  1. Medizinische Klinik I, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52057, Aachen, Deutschland

    S. Krüger

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Krüger, S. Biomarker im Management pulmonaler Infektionen. Pneumologe 6, 203–212 (2009). https://doi.org/10.1007/s10405-008-0301-1

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