Taking the Guesswork out of ICU Pneumonia Diagnosis

Vicky Enne, BSc, PhD, and Vanya Gant, MBBS, PhD, believe there’s a better way to diagnose pneumonia-causing pathogens in intensive care units (ICUs).

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

In an exclusive interview with Contagion, these investigators detailed their multi-center, randomized, controlled trial, INHALE.

INHALE examined the utility of rapid diagnostics for hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) in critical care. The data were shared as a late breaking clinical trial at the IDWeek 2022 conference.

“We took the [BioFire] FilmArray Pneumonia Panel…to find the etiological diagnosis of pneumonia, and we put that in a randomized control trial,” Enne explained. “It was a multi-center trial of 14 different ICUs.”

What made this trial unique was that the team specifically placed the device at the product of care in the ICU. “We did this for 2 reasons,” said Enne, “number 1 so that we would not lose transport time, and secondly so that ICU physicians would feel more ownership of the test.”

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

The investigators emphasized that this trial was “completely real life” with no participants excluded; they wanted to mimic what actually happens in the ICU.

The study found that the proportion of patients on antibiotics improved by 20%, compared to the control group. However, the study failed to meet the inferiority margin for clinical cure. “We do not fully understand why,” said Enne, but this result has prompted further investigation. Gant clarified, “The diagnosis that the machine made we believe to be absolutely correct.”

Without a rapid and reliable diagnostic test, said Gant, “You give antibiotics that you think are a best bet, depending on where you are in the world and what the local bugs are resistant to, but it’s guesswork, and we should be able to do better.”

This study, “INHALE WP3: Results of a multi-center rrandomized controlled trial (INHALE) testing the utility of rapid multiplex PCR at point-of-care for the antibiotic management of hospital-acquired and ventilator-associated pneumonia in critical care,” was presented as a late-breaking vaccine study during the IDWeek 2022 conference, held October 19-23, 2022, in Washington, D.C.