Novel diagnostics of respiratory infection in the intensive care unit

Pneumonia is one the leading causes of a critical care admission and is associated with substantial mortality and morbidity. Despite this, the diagnosis of pneumonia and identifying the causative pathogen is not always straight forward, particularly in the immunocompromised or those already receiving antibiotics. Medical belief today encourages the use of broad spectrum antimicrobials in all patients that may have pneumonia. This approach invariably leads to overtreatment of many patients, with consequent side effects. These side effects may lead to an insidious impact on organ function or overgrowth of harmful organisms (e.g., Clostridium difficile) which in turn can adversely affect outcome, reduce institutional efficiency and increase healthcare costs. At a society level, it is this over-use of broad spectrum antimicrobials that is helping drive the spread of anti-microbial resistance. Clinicians, urgently need reliable diagnostic aids to inform them that their patient does or does not have an infection and to reliably and rapidly identify the pathogen with any associated resistance genes. Only then can we confidently withhold or prescribe the appropriate antimicrobial.