Abstract
BackgroundEarly detection of infection is critical to rapidly starting effective treatment. Diagnosis can be difficult, particularly in the intensive care unit (ICU) population. Because the presence of polymorphonuclear neutrophils in tissues is the hallmark of inflammatory processes, the objective of this proof of concept study was to determine whether the measurement of reactive oxygen species (ROS) could be an efficient diagnostic tool to rapidly diagnose infections in peritoneal, pleural and bronchoalveolar lavage (BAL) fluids in ICU patients.MethodsWe prospectively included all patients hospitalized in the 21-bed surgical ICU of a teaching hospital from June 2010 to February 2014 who presented with systemic inflammatory response syndrome with suspicion of a peritoneal or pleural fluid or pulmonary infection needing a BAL. Instantaneous basal ROS production was measured in fluids and after phorbol 12-myristate 13-acetate (PMA) stimulation. We compared patients with infected fluids to those with non-infected fluids.ResultsThe overall ICU mortality rate was 34 %. A majority of patients were sampled following a delay of 5 days (2–12) after ICU admission, with most receiving antibiotics at the time of fluid sampling (71 %). Fluids were infected in 21/65 samples: 6/17 peritoneal fluids, 8/28 pleural fluids and 7/20 BALs. ROS production was significantly higher in the infected than in the non-infected group at baseline and after PMA stimulation in the peritoneal and pleural fluids but not in BAL.ConclusionAssessing instantaneous ROS production appears as a fast and reliable diagnostic method for detecting peritoneal and pleural fluid infection.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0142-8) contains supplementary material, which is available to authorized users.
Highlights
Detection of infection is critical to rapidly starting effective treatment
Lung infection detected by bronchoalveolar lavage (BAL) was defined by a bacterial quantitative culture ≥104 colony-forming units (CFU)/ml [11,12,13,14], with a cell count ≥105/ mm3 containing more than 50 % Polymorphonuclear neutrophils (PMNs) [15]
We analyzed 67 patients with systemic inflammatory response syndrome (SIRS) and suspected of having an infection requiring fluid sampling that was analyzed for reactive oxygen species (ROS) analysis
Summary
Detection of infection is critical to rapidly starting effective treatment. Diagnosis can be difficult, in the intensive care unit (ICU) population. Because the presence of polymorphonuclear neutrophils in tis‐ sues is the hallmark of inflammatory processes, the objective of this proof of concept study was to determine whether the measurement of reactive oxygen species (ROS) could be an efficient diagnostic tool to rapidly diagnose infections in peritoneal, pleural and bronchoalveolar lavage (BAL) fluids in ICU patients. Intensive Care (2016) 6:41 inflammatory processes related to different triggers [3] Among their activated functions, the production of reactive oxygen species (ROS), mainly from NADPH oxidase activation, is an essential step in the killing of bacteria [4]. We hypothesized that PMNs’ ROS production, as we previously published [5], could be higher during infection-induced inflammation than in sterile inflammation This could help diagnose peritoneal, pleural and bronchoalveolar fluid infection more rapidly
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