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Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.

Hellyer, Thomas P and Morris, Andrew Conway and McAuley, Daniel F and Walsh, Timothy S and Anderson, Niall H and Singh, Suveer and Dark, Paul and Roy, Alistair I and Baudouin, Simon V and Wright, Stephen E and Perkins, Gavin D and Kefala, Kallirroi and Jeffels, Melinda and McMullan, Ronan and O'Kane, Cecilia M and Spencer, Craig and Laha, Shondipon and Robin, Nicole and Gossain, Savita and Gould, Kate and Ruchaud-Sparagano, Marie-Hélène and Scott, Jonathan and Browne, Emma M and MacFarlane, James G and Wiscombe, Sarah and Widdrington, John D and Dimmick, Ian and Laurenson, Ian F and Nauwelaers, Frans and Simpson, A John (2015) Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax, 70 (1). pp. 41-7. ISSN 1468-3296. This article is accessible to all HEFT staff and students via NICE journals and databases http://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases by using their HEFT Athens login IDs

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Official URL: http://thorax.bmj.com/content/70/1/41.long

Abstract

BACKGROUND

Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare.

OBJECTIVES

We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP.

METHODS

A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination.

RESULTS

Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p<0.001). The area under the receiver operator characteristic curve for IL-1β was 0.81; IL-8, 0.74; MMP-8, 0.76; MMP-9, 0.79 and HNE, 0.78. A combination of IL-1β and IL-8, at the optimal cut-point, excluded VAP with a sensitivity of 100%, a specificity of 44.3% and a post-test probability of 0% (95% CI 0% to 9.2%).

CONCLUSIONS

Low BALF IL-1β in combination with IL-8 confidently excludes VAP and could form a rapid biomarker-based rule-out test, with the potential to improve antibiotic stewardship.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NICE journals and databases http://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases by using their HEFT Athens login IDs
Subjects: WB Practice of medicine > WB400 Intensive care
WC Communicabable diseases
Divisions: Clinical Support > Critical Care
Clinical Support > Infection Control
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 31 May 2015 07:23
Last Modified: 31 May 2015 07:23
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/943

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