Bacterial quantitation in clinical infection: a systematic review
Issued Date
2026-04-30
Resource Type
eISSN
14712970
Scopus ID
2-s2.0-105037562503
Pubmed ID
42057720
Journal Title
Philosophical Transactions of the Royal Society of London Series B Biological Sciences
Volume
381
Issue
1949
Rights Holder(s)
SCOPUS
Bibliographic Citation
Philosophical Transactions of the Royal Society of London Series B Biological Sciences Vol.381 No.1949 (2026)
Suggested Citation
Benjamin A., Phommasone K., White N.J., Ashley E.A. Bacterial quantitation in clinical infection: a systematic review. Philosophical Transactions of the Royal Society of London Series B Biological Sciences Vol.381 No.1949 (2026). doi:10.1098/rstb.2024.0346 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116634
Title
Bacterial quantitation in clinical infection: a systematic review
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Corresponding Author(s)
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Abstract
Pivotal clinical studies of new anti-infective drugs enrol patients with strictly defined clinical syndromes, with clinical and laboratory endpoints used to define treatment success. Assessing bacterial killing in the host by serial quantitation has potential as a more efficient pharmacometric approach to assess antibiotic efficacy. We conducted a systematic review of the use of bacterial quantitation in clinical infection. The main syndromes studied in the 222 included articles were bacteraemia, chronic respiratory disease, diarrhoea, pneumonia and sexually transmitted infections. Most reports (135 articles, 61%) quantified bacterial load in different specimen types using quantitative polymerase chain reaction (qPCR). For bacteraemias, bacterial DNA load measured in whole blood by qPCR at clinical presentation was typically 2-3 log10 copies ml-1, usually substantially higher than the estimates from quantitative culture. Higher bacterial loads were associated with increased mortality in 28 of 35 studies. Faster bacterial clearance was correlated with appropriate antibiotic therapy and improved outcome in the majority of studies. Most studies sampled too infrequently for accurate characterization of bacterial clearance rates. The rate of bacterial clearance from blood or other compartments is an informative pharmacodynamic endpoint in the assessment of antibacterial therapeutic effects, but standardized approaches to assessment are needed based on optimal study design. This article is part of the Theo Murphy meeting issue 'Evaluating anti-infective drugs'.