Topics

Evaluation of pentraxin3 as a Marker for Ventilator Associated Pneumonia

2019-10-07 08:56:51 | BioPortfolio

Summary

This study will assess the role of pentraxin3 (PTX3) in the early diagnosis of ventilator-associated pneumonia (VAP) and the detection of antibiotic sensitivity for different organisms isolated from tracheal aspirate.

Description

Ventilator associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs more than 48h after endotracheal intubation. This can be further classified into early onset (within the first 96 hours of mechanical ventilation (MV) and late onset (more than 96 hours after the initiation of MV), which is more commonly attributable to multidrug-resistant pathogens Ventilator associated pneumonia is common in critical care patients and is responsible for around half of all antibiotics given to patients in intensive care units. International Nosocomial Infection Control Consortium suggest that the overall rate of VAP is 13.6 per 1000 ventilator days. However, the individual rate varies according to patient group, risk factors and hospital setting. The average time taken to develop VAP from the initiation of MV is around 5 to 7 days, with a mortality rate quoted as between 24% and 76%.

The key to the development of VAP is the presence of an endotracheal tube (EET) or tracheostomy, both of which interfere with the normal anatomy and physiology of respiratory tract, specifically the functional mechanisms involved in clearing secretion (cough and mucociliary action).

Intubated patients have a reduced level of consciousness that impairs voluntary clearance of secretions, which may then pool in the oropharynx. This leads to the macro aspiration and micro aspiration of contaminated oropharyngeal secretions that are rich in harmful pathogens. Normal oral flora starts to proliferate and are able to pass along the tracheal tube, forming an antibiotic-resistant biofilm which eventually reaches the lower airways.

Critically unwell patients exhibit an impaired ability to mount an immune response to these pathogens, leading to the development of a pneumonia.

Early-onset VAP, occurring within the first four days of MV, is usually caused by antibiotic-sensitive community-acquired bacteria such as Hemophilus and Streptococcus. VAP developing more than 5 days after initiation of MV is usually caused by multidrug-resistant bacteria such as Pseudomonas aeruginosa.

The clinical pulmonary infection score (CPIS) based on variables (fever, leukocytosis, tracheal aspirates, oxygenation radiographic infiltrates). CPIS is helpful to diagnosis VAP in patient but it is not sufficient for definite diagnosis.

The accurate diagnosis of VAP in children and adults is still an unsolved problem, delayed diagnosis of VAP and subsequent delay in initiating appropriate therapy may cause worse outcomes in patients with VAP. On the other hand, an incorrect diagnosis may lead to unnecessary treatment and subsequent complications that are related to therapy. Over-treatment with antibiotics increases clinical risks such as Clostridium difficile-associated colitis and antibiotic resistance.

Several criteria have been proposed for diagnosing VAP in clinical settings, including clinical manifestations, imaging techniques, methods to obtain and interpret bronchoalveolar specimens, and biomarkers of host response. However, there is no acceptable gold standard modality yet and the accuracy of these methods in diagnosing VAP is controversial.

Microbiological analysis and identification of organisms may take 48-72 h, false-negative results may occur as a result of concomitant or previous antibiotic treatment, whereas false positives may represent colonization or sampling errors. Biomarkers have been seen as a potential avenue for improving speed and accuracy of clinical diagnosis, or to allow withdrawal of therapy because of the clinical resolution of VAP.

Pentraxins are phylogenetically conserved proteins characterized by a multimeric structure and divided into short (C -reactive protein (CRP) and serum amyloid P component) and long pentraxins.

PTX3 is the first identified member of the long pentraxin subfamily. It can be rapidly produced and released by mononuclear phagocytes, neutrophils, epithelial and endothelial cells in response to primary inflammatory signals (IL-1, and TNF-α).

Pentraxin3 (PTX3) is an acute-phase inflammatory mediator whose levels increase rapidly in inflammatory and infectious conditions. Increased PTX3 levels are correlated with the severity of lung injury and infection.

Study Design

Conditions

Ventilator Associated Pneumonia

Intervention

pentraxin 3 marker

Status

Not yet recruiting

Source

Assiut University

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-10-07T08:56:51-0400

Clinical Trials [856 Associated Clinical Trials listed on BioPortfolio]

Study on ICU Patients With Nosocomial Lower Respiratory Tract Infections

This is a multicentre, multinational, prospective observational investigation on ICU critically ill patients affected by nosocomial pneumonia, defined as: Out of ICU Hospital-acquired Pneu...

Investigation of Compliance With Ventilator-Associated Pneumonia Prevention Methods and Incidence of Ventilator-Associated Pneumonia in Intensive Care Units

Ventilator-associated Pneumonia (VAP) is a high-mortality hospital infection that occurs in patients undergoing invasive Mechanical Ventilation (MV) and is frequently encountered in intens...

The Diagnostic and Prognostic Utility of Procalcitonin (ProCT) for Ventilator-associated Pneumonia (VAP)

Our aim in this study is to investigate the potential role of serum ProCT as an early diagnostic marker and later prognostic indicator for VAP.

The Effect of Colistin Inhalation on Ventilator Associated Pneumonia

The study has been conducted to measure the clinical outcome of early intervention with colistin inhalation in patients with ventilator associated pneumonia suspected to have multidrug res...

Effect of Aerosolised Colistin in Ventilator Associated Pneumonia

the management of Ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) gram-negative bacilli (GNB) represent a real therapeutic dilemma in intensive care unit (ICU). C...

PubMed Articles [2755 Associated PubMed Articles listed on BioPortfolio]

Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review.

Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare associated pneumonia (NV-HAP) is both underreported a...

Modern approaches to treatment of pseudomonas aeruginosa ventilator-associated pneumonia (literature review).

Introduction: Nowadays anti-microbial therapy of ventilator-associated pneumonia caused by is one of the most topical issue as a consequence of widespread multiresistant strains of causative agent and...

Effect of previous antibiotic therapy on the epidemiology of ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care patients. The aim of the study was to evaluate the effect of previous antibiotic therapy on the incidenc...

Adhering to the procalcitonin algorithm allows antibiotic therapy to be shortened in patients with ventilator-associated pneumonia.

Ventilator-associated pneumonia (VAP) increases exposure to antibiotics. Physicians are however reluctant to shorten treatment, arguing this could lead to failures and worse outcome. Monitoring procal...

Good practices for preventing ventilator-associated pneumonia in the emergency department.

To evaluate the conformity of the set of good practices for preventing ventilator-associated pneumonia (VAP) in the emergency department of a university hospital.

Medical and Biotech [MESH] Definitions

Serious INFLAMMATION of the LUNG in patients who required the use of PULMONARY VENTILATOR. It is usually caused by cross bacterial infections in hospitals (NOSOCOMIAL INFECTIONS).

Lung damage that is caused by the adverse effects of PULMONARY VENTILATOR usage. The high frequency and tidal volumes produced by a mechanical ventilator can cause alveolar disruption and PULMONARY EDEMA.

Pneumonia caused by infection with bacteria of the family RICKETTSIACEAE.

Pneumonia due to aspiration or inhalation of various oily or fatty substances.

A species of the genus PNEUMOVIRUS causing pneumonia in mice.

More From BioPortfolio on "Evaluation of pentraxin3 as a Marker for Ventilator Associated Pneumonia"

Quick Search

Relevant Topics

Pulmonary
Pulmonary relating to or associated with the lungs eg Asthma, chronic bronchitis, emphysema, COPD, Cystic Fibrosis, Influenza,  Lung Cancer, Pneumonia, Pulmonary Arterial Hypertension, Sleep Disorders etc Follow and track Lung Cancer News ...

Pneumonia
Pneumonia (bronchopneumonia, lobar pneumonia and double pneumonia) is inflammation (swelling) of the tissue in one or both of your lungs. It is usually caused by an pneumococcal infection caused by bacteria called Streptococcus pneumoniae.  However,...

Palliative Care
Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the ...


Searches Linking to this Trial