Endotracheal Aspirates is less invasive and less costly in detecting ventilator-associated pneumonia, a common hospital infection in the era of COVID-19
PHOENIX, Ariz. — Oct. 1, 2020 — As ventilator use in hospitals skyrockets during the COVID-19 pandemic, results of a study by HonorHealth Research and Innovation Institute, the Translational Genomics Research Institute (TGen), City of Hope, and the University of Arizona suggests there may be a better way to diagnose ventilator-associated pneumonia (VAP).
The findings of this study, which was supervised by Patrick Pirrotte, Ph.D., Director of TGen’s Collaborative Center for Translational Mass Spectrometry, were published today in the scientific journal Molecular & Cellular Proteomics.
Intensive care unit (ICU) patients with prolonged hospitalizations, and in need of a mechanical device to help them breathe, are at high risk for developing VAP, which can increase the length and cost of hospital stays by as much as $50,000 per patient. VAP is associated with 60% of all hospital-acquired infections. VAP is also associated with more than half of ICU antibiotic use, which can lead to multi-drug resistance.
Currently, the most common way of diagnosing VAP and guiding treatment options is through the use of bronchoalveolar lavage (BAL), in which an invasive bronchoscope is passed through the mouth or nose deep into the patient’s airway and lungs, with a measured amount of fluid introduced and then collected for examination.
The TGen-led research team assessed an alternative method called endotracheal aspirates (ETA), a non-invasive, faster and less costly diagnostic test in which respiratory secretions are suctioned from the lungs of patients using the already inserted intubation tube. This study represents the first detailed characterization of ETA proteins and metabolites.
“ETA has been historically overlooked in favor of BAL,” said Khyati Pathak, Ph.D., a staff scientist in TGen’s Collaborative Center for Translational Mass Spectrometry, and one of the study’s lead authors.
Marissa McGilvrey, a research associate in Dr. Pirrotte’s lab, and one of the study’s lead authors agrees, “Our study revealed that ETA is functionally diverse and highly enriched in proteins involved in immunity, suggesting that ETA is an attractive source to study lung infection.”
The study involved 16 patients under mechanical ventilation in the ICU trauma center at HonorHealth Scottsdale Osborn Medical Center. Eleven of the patients acquired VAP.
“Intubation is one of the most common interventions in critical care and has been linked to increased susceptibility of lung infection and death,” said Charles Hu, M.D., a Phoenix-area trauma and critical care surgeon, and an author of the study. “Intubation procedure, duration on the ventilator, length of stay and inappropriate antibiotic treatment, as well as compromised or weakened immunity, may contribute to the development of pneumonia.”
ETA provides more frequent ‘molecular snapshots’
One of the advantages of ETA is that it can easily be done repeatedly without invasive procedure. ETA was collected daily, starting at the first day of intubation. BAL was collected as part of current standard-of-care procedures and used for microbial cultures to aid in clinical diagnosis.
“We hypothesized that reduced invasiveness involved in ETA sampling allows easier and more frequent molecular snapshots of the patient immune response,” said Frederic Zenhausern, Ph.D, M.B.A., Director of the Center for Applied NanoBioscience and Medicine at the University of Arizona, and one of the study authors. He also holds appointments at TGen and HonorHealth. “We anticipated that this enhanced granularity would provide valuable mechanistic insights into the causes of VAP.”
Researches showed that ETA captures a rich and diverse airway proteome, enabling detection of VAP pathogen peptides and immune proteins associated with an early response to infection.
“In the majority of VAP patients, these distinctive pathogen signatures found through ETA were present up to two days earlier than the BAL culture-based diagnosis,” said Dr. Pirrotte, the study’s senior author. “ETA may be an attractive alternative for earlier and cost-effective clinical diagnosis of pneumonia in intubated patients.”
This study — Molecular profiling of innate immune response mechanisms in ventilator-associated pneumonia — was funded by the Flinn Foundation and TGen. HonorHealth Research and Innovation Institute trauma research at Scottsdale Osborn Medical Center enrolled patients and collected data. City of Hope, a world-renowned independent research and treatment center for cancer, diabetes and other life-threatening diseases, provided statistical analysis and reviewed data interpretation.
About TGen, an affiliate of City of Hope
Translational Genomics Research Institute (TGen) is a Phoenix, Arizona-based nonprofit organization dedicated to conducting groundbreaking research with life-changing results. TGen is affiliated with City of Hope, a world-renowned independent research and treatment center for cancer, diabetes and other life-threatening diseases: CityofHope.org. This precision medicine affiliation enables both institutes to complement each other in research and patient care, with City of Hope providing a significant clinical setting to advance scientific discoveries made by TGen. TGen is focused on helping patients with neurological disorders, cancer, diabetes and infectious diseases through cutting-edge translational research (the process of rapidly moving research toward patient benefit). TGen physicians and scientists work to unravel the genetic components of both common and complex rare diseases in adults and children. Working with collaborators in the scientific and medical communities worldwide, TGen makes a substantial contribution to help our patients through efficiency and effectiveness of the translational process. For more information, visit: tgen.org. Follow TGen on Facebook, LinkedIn and Twitter @TGen.
HonorHealth is a non-profit, local community healthcare system serving an area of 1.6 million people in the greater Phoenix area. The network encompasses six acute-care hospitals, an extensive medical group, outpatient surgery centers, a cancer care network, clinical research, medical education, a foundation and community services with approximately 12,300 employees, 3,700 affiliated physicians and 3,100 volunteers. HonorHealth was formed by a merger between Scottsdale Healthcare and John C. Lincoln Health Network. HonorHealth’s mission is to improve the health and well-being of those we serve. Learn more at HonorHealth.com
About HonorHealth Research and Innovation Institute
HonorHealth Research and Innovation Institute is helping shape the future of medicine. We're finding cures and improving treatments in areas like gene therapy, early drug/device development, early detection and prevention of disease. Through our clinical trials and applied research, we’ve given hope and improved the lives of patients from all 50 states and 28 different countries around the globe. Our advanced technologies and cutting-edge treatment options are introducing tomorrow’s cures, today. For more information on oncology clinical trials for pancreatic cancer email firstname.lastname@example.org or learn more at HonorHealth.com/research. Follow HonorHealth Research and Innovation Institute on Facebook, LinkedIn and Twitter @HRInstitute_AZ.