New diagnostic and prognostic markers of ventilator-associated pneumonia.
OBJECTIVE
The purpose of this review is to analyze the potential advantages and drawbacks of using biomarkers of bacterial infection for the diagnosis and prognosis of ventilator-associated pneumonia.


RESULTS
Whereas procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have both greater diagnostic accuracies than most commonly used clinical parameters and other biomarkers of infection, such as C-reactive protein, they can be increased in noninfectious conditions or remain low in patients with true infection. Furthermore, these assays cannot determine the causative organisms and associated patterns of antibiotic susceptibility.


CONCLUSIONS
Procalcitonin and sTREM-1 should be used only as a complementary tool, to reinforce the usual diagnostic work-up. However, serial serum procalcitonin and sTREM-1 measurements may provide an opportunity to change the treatment early in the course of patients with ventilator-associated pneumonia, either to intensify treatment when their levels stay high, or to avoid unnecessary prolonged courses of antibiotics when their levels rapidly decrease. Whether procalcitonin and/or sTREM-1 guidance can reduce antibiotic use in such a setting will require additional studies, but such a strategy appears promising.
Chastre
Jean
J
Medical Intensive Care Unit, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France. jean.chastre@psl.aphp.fr
Luyt
Charles-Edouard
CE
Trouillet
Jean-Louis
JL
Combes
Alain
A
D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003428:Cross Infection / Q000175:diagnosis* / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D006801:Humans; D008562:Membrane Glycoproteins / Q000097:blood*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011971:Receptors, Immunologic / Q000097:blood*; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
D015415:Biomarkers; C000606589:CALCA protein, human; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide