Digital biomarkers from sweat analysis for therapeutic drug monitoring in soft tissue infections

Abstract

Antimicrobial resistance is increasing morbidity and mortality and significantly affecting global health. Inappropriate use of antimicrobial drugs can lead to antimicrobial resistances and serious side effects. Therapeutic drug monitoring (TDM) at the point of need has been proven to be a valuable tool to prevent the emergence of antimicrobial resistances. However, TDM focuses on blood levels rather than concentrations at the source of infection. There is no reliable TDM monitoring approach in soft tissue infections, despite significant interpersonal differences in antibiotic tissue penetration, e.g., in patients with peripheral arterial disease. The excretion of a variety of antibiotics into sweat has been a very promising surrogate marker for tissue penetration. Novel wearable on-skin sweat analysing biosensors are increasingly available. Those biosensors are based on different sensing approaches such as electrochemical or aptameric sensors. They are connectable mostly through Bluetooth with the users' device and enable a lab-independent point-of-care analysis. Despite that a specific on-skin detecting device for antibiotics remains lacking yet, wearable sweat analysis is a very promising, novel approach to provide antimicrobial TDM in soft tissue infections and needs further investigation.