A rapid diagnostic test for ventilator associated pneumonia?
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Specialist Registrar, Lok Nayak Hospital, Delhi, India; sanjayzak@hotmail.com
Gibot S, Cravoisy A, Levy B, et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 2004;350:451–8
The diagnosis of ventilator associated pneumonia (VAP) is both contentious and frustrating for the intensivist. This study evaluates the effectiveness of using soluble triggering receptor expressed on myeloid cells (sTREM)-1, a member of the immunoglobulin superfamily expressed in response to bacterial or fungal infections, as a tool for the rapid diagnosis of VAP. A total of 148 patients requiring mechanical ventilation and with a clinical suspicion of pneumonia were prospectively enrolled in the study. Mini bronchoalveolar lavage was performed and the collected sample used for quantitative bacterial culture and assay of sTREM-1 and the inflammatory cytokines tumour necrosis factor (TNF)- and interleukin (IL)-1?. VAP was diagnosed on the basis of new persistent infiltrates on chest radiography, significant bacterial growth on culture (103 CFU/ml of lavage fluid), and either purulent tracheal secretions, pyrexia, leucocytosis, or leucopenia. The sTREM-1 assay reliably diagnosed pneumonia with a sensitivity of 98% and specificity of 90%. Using multiple logistic regression analysis among the predictors of pneumonia (clinical pulmonary infection score, sTREM-1, TNF- and IL-1?), sTREM-1 emerged as the strongest indicator (odds ratio 41.5).
The authors conclude that sTREM-1 assay may be a useful tool in both the rapid diagnosis of VAP and the reliable differentiation from non-infectious causes of fever and radiographic pulmonary infiltrates in ventilated patients.(S Zachariah)
Gibot S, Cravoisy A, Levy B, et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 2004;350:451–8
The diagnosis of ventilator associated pneumonia (VAP) is both contentious and frustrating for the intensivist. This study evaluates the effectiveness of using soluble triggering receptor expressed on myeloid cells (sTREM)-1, a member of the immunoglobulin superfamily expressed in response to bacterial or fungal infections, as a tool for the rapid diagnosis of VAP. A total of 148 patients requiring mechanical ventilation and with a clinical suspicion of pneumonia were prospectively enrolled in the study. Mini bronchoalveolar lavage was performed and the collected sample used for quantitative bacterial culture and assay of sTREM-1 and the inflammatory cytokines tumour necrosis factor (TNF)- and interleukin (IL)-1?. VAP was diagnosed on the basis of new persistent infiltrates on chest radiography, significant bacterial growth on culture (103 CFU/ml of lavage fluid), and either purulent tracheal secretions, pyrexia, leucocytosis, or leucopenia. The sTREM-1 assay reliably diagnosed pneumonia with a sensitivity of 98% and specificity of 90%. Using multiple logistic regression analysis among the predictors of pneumonia (clinical pulmonary infection score, sTREM-1, TNF- and IL-1?), sTREM-1 emerged as the strongest indicator (odds ratio 41.5).
The authors conclude that sTREM-1 assay may be a useful tool in both the rapid diagnosis of VAP and the reliable differentiation from non-infectious causes of fever and radiographic pulmonary infiltrates in ventilated patients.(S Zachariah)