Biomarker-based exclusion of VAP for improved antibiotic stewardship

• Research type

  Research Study

• Full title

  A randomised controlled trial of biomarker-based exclusion of VAP to improve antibiotic stewardship.

• IRAS ID

  111870

• Contact name

  John Simpson

• Contact email

  j.simpson@ncl.ac.uk

• Sponsor organisation

  NUTH Hospitals NHS Foundation Trust

• Research summary

  Critically ill patients whose lungs are supported by breathing machines (ventilators) commonly develop new lung infection, called ventilator-associated pneumonia (VAP). Because VAP is often fatal, antibiotics are usually administered when VAP is suspected. However VAP is hard to distinguish from several non-infective lung conditions and most patients with suspected VAP do not have pneumonia. Therefore many patients receive unnecessary antibiotics for several days, promoting emergence of ‘superbugs’ and exposing patients to costly antibiotics with potential side effects.

  Full standard laboratory infection results for VAP typically return in 3 days.
  A simple test rapidly and confidently excluding VAP would improve patient care, reduce unnecessary antibiotics and decrease costs. We recently showed that low levels of specific proteins in fluid from the lungs of patients with suspected VAP effectively excluded VAP, using a test that may yield results within 4-6 hours. The test used is an extension of existing technology produced by our commercial partner Becton Dickinson (BD) Biosciences. However the test’s ability to improve antibiotic use has not yet been compared with standard use of antibiotics for suspected VAP, and this is the important next step.

  The aim of this new study is therefore to determine whether our novel test can improve care of patients with suspected VAP by reducing the amount of unnecessary antibiotics. This will be done using a randomised controlled trial (the gold standard scientific way of evaluating a diagnostic test) across hospitals in the UK, in which 50% of patients will receive standard antibiotic therapy for suspected VAP and the other 50% will have the new test, with a recommendation to consider stopping antibiotics if the test suggests VAP is highly unlikely. The trial seeks to establish whether there is a place for the new test in improving care for patients with suspected VAP.

• REC name

  London - Camberwell St Giles Research Ethics Committee

• REC reference

  13/LO/0651

• Date of REC Opinion

  28 Jun 2013

• REC opinion

  Further Information Favourable Opinion