Abstract
Ventilator-associated pneumonia (VAP) remains the most common nosocomial infection in ICUs. VAP occurs in 10–20% of patients who are mechanically ventilated for more than 48 h. The interval between diagnosis and the availability of microbiological results is the period when clinicians would most benefit from a reliable biomarker that could provide an early indication of poor response. Serum-soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) belongs to the immunoglobin superfamily, and it has the advantage of being increased during infectious processes but not in noninfectious inflammatory conditions. The aim of this study was to assess the value of serum level of sTREM-1 as a diagnostic biomarker for VAP in comparison with commonly used indicators, including procalcitonin (PCT) and C-reactive protein (CRP). This study was carried out on 60 participants. They were divided into two groups: group I included 30 adult patients with clinically suspected VAP, and group II included 30 ICU ventilated patients of the same age group without VAP and free of other infectious diseases who served as the control group. They were selected from the ICUs of Chest and other Departments, Tanta University Hospitals, during the period from January 2014 until September 2014. The present study revealed that serum level of sTREM-1 was significantly higher in patients with VAP in comparison with the control group. It was also concluded that serum level of sTREM-1 was significantly higher in VAP patients with bacterial growth culture results than in VAP patients with no growth culture results. A diagnostic cutoff value greater than 110 pg/ml with a sensitivity of 87.5%, specificity of 83.3%, positive predictive value of 95.5%, and negative predictive value of 62.5% of serum sTREM-1 level could discriminate positive culture results from negative culture results in VAP patients, which were higher than that of serum levels of PCT and CRP. It was concluded that serum level of sTREM-1 was significantly higher in VAP patients in comparison with non-VAP patients and it showed the highest sensitivity and specificity (87.5 and 83.3%, respectively) in differentiating between VAP patients with bacterial growth culture results and VAP patients with no growth culture results compared with PCT and CRP levels, thus rendering serum level of sTREM-1 a novel diagnostic marker for VAP. Egypt J Broncho 2015 9:261–268 © 2015 Egyptian Journal of Bronchology.
Highlights
Ventilator-associated pneumonia (VAP) is a type of nosocomial pneumonia that occurs in patients who receive mechanical ventilation
Some of the biomarkers that are used as an adjunct in the diagnosis of pneumonia include C-reactive protein (CRP), leukocyte count, immunoglobulins, and proinflammatory cytokines
CRP, C-reactive protein; PCT, procalcitonin; sTREM-1, soluble triggering receptor expressed on myeloid cells-1
Summary
Ventilator-associated pneumonia (VAP) is a type of nosocomial pneumonia that occurs in patients who receive mechanical ventilation. VAP is usually acquired in the hospital-setting ∼48–72 h after mechanical ventilation [1]. VAP prolongs patients’ mean ICU stay by an estimated 6.1 days and results in high financial costs [2]. The associated organisms and their resistance patterns vary on the basis of the patient group and hospital setting [1]. Most cases of VAP are caused by bacterial pathogens that normally colonize the oropharynx and gut, or that are acquired through transmission from healthcare workers, from environmental surfaces, or from other patients. Common pathogens include Pseudomonasspp.andotherhighlyresistantgram-negative Bacilli, Staphylococci, the Enterobacteriaceae, Streptococci, and Haemophilus spp. [3]
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