New biomarkers for respiratory infections.
Journal
Current opinion in pulmonary medicine
ISSN: 1531-6971
Titre abrégé: Curr Opin Pulm Med
Pays: United States
ID NLM: 9503765
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
pubmed:
19
2
2020
medline:
4
2
2021
entrez:
19
2
2020
Statut:
ppublish
Résumé
Although pneumonia, either community or hospital-acquired, is the most frequent severe respiratory infection, it is an infection difficult to diagnose. At present, the diagnosis of pneumonia relies on a combination of clinical, radiologic, and microbiologic criteria. However, these criteria are far from perfect leading to uncertainty in the diagnosis, risk stratification, and choice of antibiotic therapy. Biomarkers have been used to bring additional information in this setting. The aim of this review is to provide a clear overview of the current evidence for biomarkers to distinguish between patients in several clinical scenarios: to exclude pneumonia in order to withhold antibiotics, to identify the causative pathogen to target antimicrobial treatment, to identify phenotypes of inflammatory response to facilitate adjunctive treatments, to stratify the risk of severe pneumonia and provide the adequate level of care, and to monitor treatment response and de-escalate antibiotic therapy. In recent years the number of new biomarkers increased markedly in different areas like pathogen identification or host response. Although far from the ideal, there are several promising areas that could represent true evolutions in the management of pneumonia, in the near future.
Identifiants
pubmed: 32068575
doi: 10.1097/MCP.0000000000000669
pii: 00063198-202005000-00008
doi:
Substances chimiques
Anti-Bacterial Agents
0
Biomarkers
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
232-240Références
Martin-Loeches I, Povoa P, Rodriguez A, et al. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med 2015; 3:859–868.
Cillóniz C, Cardozo C, García-Vidal C. Epidemiology, pathophysiology, and microbiology of community-acquired pneumonia. Ann Res Hosp 2018; 2:1.
Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT). Eur Respir J 2017; 50: pii: 1700582.
pii: 1700582
Ewig S, Bauer T, Torres A. The pulmonary physician in critical care ∗ 4: nosocomial pneumonia. Thorax 2002; 57:366–371.
Almirall J, Bolibar I, Vidal J, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J 2000; 15:757–763.
Claessens YE, Debray MP, Tubach F, et al. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia. Am J Respir Crit Care Med 2015; 192:974–982.
Self WH, Courtney DM, McNaughton CD, et al. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med 2013; 31:401–405.
Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update. Thorax 2009; 64: (Suppl 3): iii1–iii55.
Nora D, Salluh J, Martin-Loeches I, et al. Biomarker-guided antibiotic therapy-strengths and limitations. Ann Transl Med 2017; 5:208.
Rabello LS, Pitrowsky MT, Soares M, et al. Novel biomarkers in severe community-acquired pneumonia. Rev Bras Ter Intensiva 2011; 23:499–506.
Prescott HC, Iwashyna TJ. Improving sepsis treatment by embracing diagnostic uncertainty. Ann Am Thorac Soc 2019; 16:426–429.
Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care 2015; 19:319.
van der Meer V, Neven AK, van den Broek PJ, et al. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331:26.
Falk G, Fahey T. C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies. Fam Pract 2009; 26:10–21.
Cals JW, Butler CC, Hopstaken RM, et al. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 2009; 338:b1374.
Kamat IS, Ramachandran V, Eswaran H, et al. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis 2020; 70:538–542.
Conway Morris A, Kefala K, Wilkinson TS, et al. Diagnostic importance of pulmonary interleukin-1beta and interleukin-8 in ventilator-associated pneumonia. Thorax 2010; 65:201–207.
Hellyer TP, Morris AC, McAuley DF, et al. Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax 2015; 70:41–47.
Hellyer TP, Anderson NH, Parker J, et al. Erratum to: ‘Effectiveness of biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use (VAPrapid-2): study protocol for a randomised controlled trial’. Trials 2016; 17:465.
Conway Morris A, Gadsby N, McKenna JP, et al. 16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia. Thorax 2017; 72:1046–1048.
Emonet S, Lazarevic V, Leemann Refondini C, et al. Identification of respiratory microbiota markers in ventilator-associated pneumonia. Intensive Care Med 2019; 45:1082–1092.
Zakharkina T, Martin-Loeches I, Matamoros S, et al. The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia. Thorax 2017; 72:803–810.
Scicluna BP, Klein Klouwenberg PM, van Vught LA, et al. A molecular biomarker to diagnose community-acquired pneumonia on intensive care unit admission. Am J Respir Crit Care Med 2015; 192:826–835.
Bhattacharya S, Rosenberg AF, Peterson DR, et al. Transcriptomic biomarkers to discriminate bacterial from nonbacterial infection in adults hospitalized with respiratory illness. Sci Rep 2017; 7:6548.
Banoei MM, Vogel HJ, Weljie AM, et al. Plasma metabolomics for the diagnosis and prognosis of H1N1 influenza pneumonia. Crit Care 2017; 21:97.
van Oort PM, Povoa P, Schnabel R, et al. The potential role of exhaled breath analysis in the diagnostic process of pneumonia: a systematic review. J Breath Res 2018; 12:024001.
van Oort PM, Nijsen T, Weda H, et al. BreathDx - molecular analysis of exhaled breath as a diagnostic test for ventilator-associated pneumonia: protocol for a European multicentre observational study. BMC Pulm Med 2017; 17:1.
Piskin N, Aydemir H, Oztoprak N, et al. Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: risk factors and impact on outcomes. BMC Infect Dis 2012; 12:268.
Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis 2000; 31: (Suppl 4): S131–S138.
Bhalodi AA, van Engelen TSR, Virk HS, et al. Impact of antimicrobial therapy on the gut microbiome. J Antimicrob Chemother 2019; 74:i6–i15.
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200:e45–e67.
Drancourt M, Gaydos CA, Summersgill JT, et al. Point-of-care testing for community-acquired pneumonia. Lancet Infect Dis 2013; 13:647–649.
Torres A, Lee N, Cilloniz C, et al. Laboratory diagnosis of pneumonia in the molecular age. Eur Respir J 2016; 48:1764–1778.
Dickson RP, Erb-Downward JR, Martinez FJ, et al. The microbiome and the respiratory tract. Annu Rev Physiol 2016; 78:481–504.
Jamal W, Al Roomi E, AbdulAziz LR, et al. Evaluation of Curetis Unyvero, a multiplex PCR-based testing system, for rapid detection of bacteria and antibiotic resistance and impact of the assay on management of severe nosocomial pneumonia. J Clin Microbiol 2014; 52:2487–2492.
Gadsby NJ, Russell CD, McHugh MP, et al. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis 2016; 62:817–823.
Kunze N, Moerer O, Steinmetz N, et al. Point-of-care multiplex PCR promises short turnaround times for microbial testing in hospital-acquired pneumonia: an observational pilot study in critical ill patients. Ann Clin Microbiol Antimicrob 2015; 14:33.
Gadsby NJ, McHugh MP, Forbes C, et al. Comparison of Unyvero P55 Pneumonia Cartridge, in-house PCR and culture for the identification of respiratory pathogens and antibiotic resistance in bronchoalveolar lavage fluids in the critical care setting. Eur J Clin Microbiol Infect Dis 2019; 38:1171–1178.
Crum-Cianflone NF. Invasive Aspergillosis associated with severe influenza infections. Open Forum Infect Dis 2016; 3:ofw171.
Martin-Loeches I, M JS, Vincent JL, et al. Increased incidence of co-infection in critically ill patients with influenza. Intensive Care Med 2017; 43:48–58.
Bos LD, Sterk PJ, Schultz MJ. Volatile metabolites of pathogens: a systematic review. PLoS Pathog 2013; 9:e1003311.
Marshall JC. Why have clinical trials in sepsis failed? Trends Mol Med 2014; 20:195–203.
Russell JA, Fjell C, Hsu JL, et al. Vasopressin compared with norepinephrine augments the decline of plasma cytokine levels in septic shock. Am J Respir Crit Care Med 2013; 188:356–364.
Famous KR, Delucchi K, Ware LB, et al. Acute respiratory distress syndrome subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med 2017; 195:331–338.
Seymour CW, Kennedy JN, Wang S, et al. Derivation, validation, and potential treatment implications of novel clinical phenotypes for sepsis. JAMA 2019; 321:2003–2017.
Talisa VB, Yende S, Seymour CW, et al. Arguing for adaptive clinical trials in sepsis. Front Immunol 2018; 9:1502.
Dellinger RP, Bagshaw SM, Antonelli M, et al. Effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: the EUPHRATES randomized clinical trial. JAMA 2018; 320:1455–1463.
Panacek EA, Marshall JC, Albertson TE, et al. Efficacy and safety of the monoclonal antitumor necrosis factor antibody F(ab’)2 fragment afelimomab in patients with severe sepsis and elevated interleukin-6 levels. Crit Care Med 2004; 32:2173–2182.
Povoa P. C-reactive protein: a valuable marker of sepsis. Intensive Care Med 2002; 28:235–243.
Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 2015; 313:677–686.
Angus DC, van der Poll T. Severe sepsis and septic shock. New Engl J Med 2013; 369:840–851.
Boomer JS, Green JM, Hotchkiss RS. The changing immune system in sepsis: is individualized immuno-modulatory therapy the answer? Virulence 2014; 5:45–56.
Delano MJ, Ward PA. Sepsis-induced immune dysfunction: can immune therapies reduce mortality? J Clin Invest 2016; 126:23–31.
Hamers L, Kox M, Pickkers P. Sepsis-induced immunoparalysis: mechanisms, markers, and treatment options. Minerva Anestesiol 2015; 81:426–439.
Cazalis MA, Friggeri A, Cave L, et al. Decreased HLA-DR antigen-associated invariant chain (CD74) mRNA expression predicts mortality after septic shock. Crit Care 2013; 17:R287.
Winkler MS, Rissiek A, Priefler M, et al. Human leucocyte antigen (HLA-DR) gene expression is reduced in sepsis and correlates with impaired TNFalpha response: a diagnostic tool for immunosuppression? PloS One 2017; 12:e0182427.
Docke WD, Randow F, Syrbe U, et al. Monocyte deactivation in septic patients: restoration by IFN-gamma treatment. Nat Med 1997; 3:678–681.
Nalos M, Santner-Nanan B, Parnell G, et al. Immune effects of interferon gamma in persistent staphylococcal sepsis. Am J Respir Crit Care Med 2012; 185:110–112.
Day CL, Kaufmann DE, Kiepiela P, et al. PD-1 expression on HIV-specific T cells is associated with T-cell exhaustion and disease progression. Nature 2006; 443:350–354.
Akinleye A, Rasool Z. Immune checkpoint inhibitors of PD-L1 as cancer therapeutics. J Hematol Oncol 2019; 12:92.
Netea MG, Joosten LA, van der Meer JW, et al. Immune defence against Candida fungal infections. Nat Rev Immunol 2015; 15:630–642.
Kullberg BJ, van de Veerdonk F, Netea MG. Immunotherapy: a potential adjunctive treatment for fungal infection. Curr Opin Infect Dis 2014; 27:511–516.
Grimaldi D, Pradier O, Hotchkiss RS, et al. Nivolumab plus interferon-gamma in the treatment of intractable mucormycosis. Lancet Infect Dis 2017; 17:18.
Paulino MC, Arroz MJ, Nora D, et al. Síndroma de Exaustão das Células T – a propósito de um caso de Aspergilose Pulmonar Invasiva refractária. Infecção e Sepsis 2018; 5:40–43.
Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections: full version. Clin Microbiol Infect 2011; 17: (Suppl 6): E1–E59.
Huang DT, Weissfeld LA, Kellum JA, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med 2008; 52:48–58. e42.
Kruger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31:349–355.
Seligman R, Meisner M, Lisboa TC, et al. Decreases in procalcitonin and C-reactive protein are strong predictors of survival in ventilator-associated pneumonia. Crit Care 2006; 10:R125.
Hillas G, Vassilakopoulos T, Plantza P, et al. C-reactive protein and procalcitonin as predictors of survival and septic shock in ventilator-associated pneumonia. Eur Respir J 2010; 35:805–811.
Christ-Crain M, Morgenthaler NG, Stolz D, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care 2006; 10:R96.
Huang DT, Angus DC, Kellum JA, et al. Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest 2009; 136:823–831.
Luo Q, Ning P, Zheng Y, et al. Serum suPAR and syndecan-4 levels predict severity of community-acquired pneumonia: a prospective, multicentre study. Crit Care 2018; 22:15.
van Oort PM, Bos LD, Povoa P, et al. Soluble urokinase plasminogen activator receptor for the prediction of ventilator-associated pneumonia. ERJ Open Res 2019; 5:00212–2018.
Ebrahimi F, Wolffenbuttel C, Blum CA, et al. Fibroblast growth factor 21 predicts outcome in community-acquired pneumonia: secondary analysis of two randomised controlled trials. Eur Respir J 2019; 53.
Leoni D, Rello J. Severe community-acquired pneumonia: optimal management. Curr Opin Infect Dis 2017; 30:240–247.
To KK, Lee KC, Wong SS, et al. Lipid metabolites as potential diagnostic and prognostic biomarkers for acute community acquired pneumonia. Diagn Microbiol Infect Dis 2016; 85:249–254.
Liu J, Wu X, Lu F, et al. Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia. Sci Rep 2016; 6:22271.
Rautanen A, Mills TC, Gordon AC, et al. Genome-wide association study of survival from sepsis due to pneumonia: an observational cohort study. Lancet Respir Med 2015; 3:53–60.
Povoa P, Salluh JI. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care 2012; 2:32.
Salluh JIF, Souza-Dantas VC, Povoa P. The current status of biomarkers for the diagnosis of nosocomial pneumonias. Curr Opin Crit Care 2017; 23:391–397.
Nobre V, Harbarth S, Graf JD, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 2008; 177:498–505.
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 2010; 375:463–474.
Stolz D, Smyrnios N, Eggimann P, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J 2009; 34:1364–1375.
Daubin C, Valette X, Thiolliere F, et al. Procalcitonin algorithm to guide initial antibiotic therapy in acute exacerbations of COPD admitted to the ICU: a randomized multicenter study. Intensive Care Med 2018; 44:428–437.
de Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 2016; 16:819–827.
Jensen JU, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med 2011; 39:2048–2058.
Pepper DJ, Sun J, Rhee C, et al. Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis. Chest 2019; 155:1109–1118.
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63:e61–e111.
Oliveira CF, Botoni FA, Oliveira CR, et al. Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med 2013; 41:2336–2343.