Pneumonia diagnosis

Take the guesswork out of diagnosing pneumonia in the ICU

Vicky Enne, BSc, PhD, and Vanya Gant, MBBS, PhD, believe there is a better way to diagnose the pathogens that cause pneumonia in intensive care units (ICUs).

“When people get really sick in an intensive care unit and develop pneumonia, you have to act fast,” Gant said. “You don’t know why, you don’t know what bacteria are, and basically you guess.”

In an exclusive interview with Contagionthese researchers detailed their multicenter, randomized, controlled trial, INHALE.

INHALE examined the usefulness of rapid diagnostics for hospital-acquired pneumonia (HAP) and hospital-acquired pneumonia (VAP) in intensive care. The data was shared as part of a late-breaking clinical trial in IDWeek 2022 Conference.

“We took the [BioFire] FilmArray Pneumonia Panel…to find the etiological diagnosis of pneumonia, and we put it into a randomized controlled trial,” Enne explained. “It was a multicenter trial of 14 different intensive care units.”

What made this trial unique was that the team specifically placed the device at the care product level in the intensive care unit. “We did this for 2 reasons,” Enne said, “number 1 to save transport time, and second to make intensive care physicians feel more ownership of the test.”

The goal of the study was to promote the use of narrow-spectrum antimicrobials, so the investigators sought to encourage critical care physicians to engage with the FilmArray Pneumonia panel. “That way they would be more likely to use it and prescribe it accordingly,” Enne said.

Investigators stressed that this trial was “completely real” and that no participants were excluded; they wanted to mimic what actually happens in intensive care.

The study found that the proportion of patients on antibiotics improved by 20% compared to the control group. However, the study did not reach the margin of inferiority for clinical cure. “We don’t fully understand why,” Enne said, but the result prompted further investigation. Gant clarified: “The diagnosis that the machine made, we believe is absolutely correct.”

Without a fast and reliable diagnostic test, Gant said, “You give antibiotics that you think are the best bet, depending on where you are in the world and local insect resistance, but that’s is a guess, and we should be able to do better.”

This study, “INHALE WP3: results of a multicenter randomized controlled trial (INHALE) testing the utility of point-of-care multiplex rapid PCR for the antibiotic management of hospital-acquired and ventilator-associated pneumonia in critical care settings”, was presented as a last-minute vaccine study during the ID Week 2022 conference, held October 19-23, 2022, in Washington, DC