A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

May, Addison K.; Brady, Jacob S.; Romano-Keeler, Joann; Drake, Wonder; Norris, Pippa; Jenkins, Judith M.; Isaacs, Richard; Boczko, Erik M.

doi:10.1378/chest.14-1687

Cited by 35 publications

(32 citation statements)

References 59 publications

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“…This is in line with previous studies that report that the respiratory microbiome is disturbed markedly during pneumonia 29 30. We extend the finding of the limited studies done in ICU-patients,25 31 32 as no control group was included in those studies and thus it was previously unknown what the ‘normal’ dynamics in the respiratory microbiome were during mechanical ventilation. One excellent study that did include a control group was performed in young and elderly non-critically ill patients 29.…”

Section: Discussionsupporting

confidence: 89%

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

Zakharkina

Martín‐Loeches

Matamoros

et al. 2017

Thorax

145

125

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Section: Discussionsupporting

confidence: 89%

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

Zakharkina

Martín‐Loeches

Matamoros

et al. 2017

Thorax

145

125

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“…Rapid diagnostic methods must therefore have the capability of influencing early antibiotic decision-making to allow for more appropriate treatment of antibiotic-resistant bacterial infection, as well as minimisation of unnecessary use of broad-spectrum agents. [19] May et al [20] described a novel strategy for the rapid diagnosis of VAP, using exhaled breath condensate fluid obtained from heat-moisture exchangers to provide a substrate for testing with the polymerase chain reaction to identify bacterial DNA. The advantage of molecular diagnostic platforms lies in the ability to diagnose pathogens and their accompanying resistance genes rapidly.…”

Section: Discussionmentioning

confidence: 99%

Empirical antimicrobial therapy for probable v. directed therapy for possible ventilator-associated pneumonia in critically injured patients

et al. 2016

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Background. Ventilator-associated pneumonia (VAP) has recently been classified as possible or probable. Although direct attributable mortality has been difficult to prove, delay in instituting appropriate therapy has been reported to increase morbidity and mortality. Recent literature suggests that in possible VAP, instituting directed therapy while awaiting microbiological culture does not prejudice outcome compared with best-guess empirical therapy. Objectives. To ascertain outcomes of directed v. empirical therapy in possible and probable VAP, respectively. Methods. Endotracheal aspirates were obtained from patients with suspected VAP. Those considered to have possible VAP were given directed therapy following culture results, whereas patients with more convincing evidence of VAP were classed as having probable VAP and commenced on empirical antimicrobials based on microbiological surveillance. Results. Pneumonia was suspected in 106 (36.8%) of 288 patients admitted during January -December 2014. Of these, 13 did not fulfil the criteria for VAP. Of the remaining 93 (32.2%), 31 (33.3%) were considered to have probable and 62 (66.7%) possible VAP. The former were commenced on empirical antimicrobials, with 28 (90.3%) receiving appropriate therapy. Of those with possible VAP, 34 (54.8%) were given directed therapy and in 28 (45.2%) no antimicrobials were prescribed. Of the latter, 24 recovered without antimicrobials and 4 died, 3 from severe traumatic brain injury and 1 due to overwhelming intra-abdominal sepsis. No death was directly attributable to failure to treat VAP. No significant difference in mortality was found between the 34 patients with possible VAP who were commenced on directed therapy and the 31 with probable VAP who were commenced on empirical antimicrobials (p=0.75). Conclusions. Delaying antimicrobial therapy for VAP where clinical doubt exists does not adversely affect outcome. Furthermore, this policy limits the use of antimicrobials in patients with possible VAP following improvement in their clinical condition despite no therapy.

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“…The predicted effect of these ecological forces in the lungs, therefore, is a state of increased immigration, decreased elimination, and favourable growth conditions for potential pathogens. 61,82–84 Understanding of these ecological forces will be informed by longitudinal, culture-independent surveys of microbial com munities in the upper and lower respiratory tracts in critically ill patients.…”

Section: The Ecological Effects Of Critical Illnessmentioning

confidence: 99%

The microbiome and critical illness

Dickson

2016

The Lancet Respiratory Medicine

365

344

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The central role of the microbiome in critical illness is supported by a half century of experimental and clinical study. The physiological effects of critical illness and the clinical interventions of intensive care substantially alter the microbiome. In turn, the microbiome predicts patients’ susceptibility to disease, and manipulation of the microbiome has prevented or modulated critical illness in animal models and clinical trials. This Review surveys the microbial ecology of critically ill patients, presents the facts and unanswered questions surrounding gut-derived sepsis, and explores the radically altered ecosystem of the injured alveolus. The revolution in culture-independent microbiology has provided the tools needed to target the microbiome rationally for the prevention and treatment of critical illness, holding great promise to improve the acute and chronic outcomes of the critically ill.

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A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

Cited by 35 publications

References 59 publications

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

Empirical antimicrobial therapy for probable v. directed therapy for possible ventilator-associated pneumonia in critically injured patients

The microbiome and critical illness

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