Ludmila Bezdíčková

🧟‍♂️ Zombies are alive. And Czech healthcare is their promised land!!! I'm not talking about horror movies. I'm talking about inflammatory markers. At this year's Antibiotic Day, I gave a talk entitled Zombie Inflammatory Markers, inspired by two brilliant, provocative papers by Brad Spellberg. 🧟 1. ESR: A 130-year-old zombie The legendary infectious diseases physician Merle Sande once said: "You know what the ESR test tells you? It tells you that the laboratory is open." And CRP? According to Spellberg and colleagues, it's missing just one letter. An A. That makes it CRAP. 😂 Why such disrespect for our beloved biomarkers? Because their diagnostic accuracy is often dismal. Across several meta-analyses, positive likelihood ratios (LR+) hover around 2 to 4. Hardly enough to meaningfully change the probability of a diagnosis. If this were a drug, with efficacy that poor, it would never get regulatory approval. 💊 But as a laboratory test? We keep ordering it. Again and again. Now, don't get me wrong. In experienced hands, ESR can provide valuable clues to a range of diagnoses. But as a routine test for diagnosing infections? Forget it! 🧟 2. Zombies are thriving in Czechia A patient with gastroenteritis is sitting up in bed, eating a sandwich, and asking to go home. CRP 150. He stays. A patient has wet gangrene of a toe. You can smell it from the doorway. CRP 5. Everything fine, then? The patient is clinically improving, but CRP is still elevated? Continue antibiotics. CRP rises on day two of treatment? Escalate antibiotics. Yet CRP is like a long-haul truck. Slow to accelerate and even slower to brake. And most importantly: Inflammatory markers measure the host response, not the presence of living bacteria. In Czechia, we love not only zombie biomarkers but also antibiotics. We prescribe them unnecessarily, continue them for too long, and often insist on normal laboratory values before we dare stop treatment. The bacteria left the building ages ago. CRP just hasn't got the memo. 💊 3. Procalcitonin: An anxiolytic for physicians PCT is hardly a diagnostic miracle. Yet randomized trials show that PCT-guided strategies can shorten antibiotic treatment. A meta-analysis of 26 RCTs involving 6,708 patients found: ✅ Antibiotic duration: 5.7 vs. 8.1 days. ✅ Antibiotic-related adverse effects: 16% vs. 22%. Why? A low PCT reassures physicians that it's safe to stop antibiotics. So perhaps procalcitonin doesn't treat the infection. It treats the physician's anxiety about stopping antibiotics. 😁 🎯 So what should we do? Before clicking that order button for inflammatory markers, ask yourself one simple question: "What will I do differently when the result comes back?" If the answer is "nothing", leave the zombie in its grave. ⚰️ As Spellberg warns, zombie tests keep marching through hospitals, searching for the innocent brains of clinicians. Let's not let them eat ours. 🧠🧟 📚 Spellberg B et al. Clin Microbiol Infect. 2025;31:1–4. Spellberg B. JAMA Netw Open. 2026;9. #AntimicrobialStewardship #InfectiousDiseases #ChoosingWisely #Antibiotics