A UCLH and UCL study which quickly identifies the cause of a patient’s pneumonia, enabling earlier optimisation of treatment, is being re-purposed to assist with the coronavirus pandemic.
Pneumonia is one of the main symptoms of severe Covid-19 and, because many critically ill Covid-19 patients can no longer breathe by themselves they are put onto mechanical ventilators. These pump air through a tube into the lungs, helping the patient to survive. However, unfortunately the ventilation also increases the risk of bacteria entering the lungs, establishing a further infection known as ‘secondary pneumonia’.
INHALE Study Investigator at UCL Dr Vicky Enne said: “Bacterial pneumonias need urgent antibiotic treatment and left untreated can cause death: administering the right antibiotics as quickly as possible at diagnosis is therefore critical to survival.
“Unfortunately it takes 2 to 3 days to grow the bacteria in the laboratory, so it’s conventional to start with broad-spectrum antibiotics, active against many types of bacteria, then to refine treatment once the lab results come through.
“To significantly reduce this delay our study aims to accurately identify the bacteria in under an hour, thereby allowing doctors to pinpoint the best antibiotic in quick time.”
The trial is evaluating cutting-edge ‘molecular diagnostics’ to identify bacteria directly from pneumonia patients’ sputum (fluid produced in lungs), without the need for lab culture. The test can pinpoint 26 pneumonia pathogens and can detect whether these have critical antibiotic resistances.
A test result is obtained in around one hour and the information aims to give the clinician early guidance on which antibiotics to use – meaning ones likely to be active against the bacteria detected. It also discourages the use of unnecessary antibiotics, which can contribute to the development of further antibiotic resistance.
INHALE has been evaluating this approach in ‘run of the mill’ ventilator pneumonia patients at 12 ICUs in England for the past six months. Now INHALE is being temporarily refocused to investigate the secondary bacterial pneumonias that Covid-19 patients get, and to guide their treatment. It has already been used in over 50 patients at hospitals including UCLH, the Royal Free, Watford General, Chelsea and Westminster and Liverpool University Hospitals.
Dr David Brealey, ICU Consultant at UCLH, said: “Having the BioFire to help identify pneumonia has been invaluable in managing Covid-19 patients on the ICU at UCLH. These patients are so sick, we cannot wait days to get a result back from the lab, and this machine gives the result direct to the treating clinician within the hour. Real, actionable intelligence is making a difference to the way we treat our patients.”
Study Chief Investigator, Dr Vanya Gant, Consultant Microbiologist at UCLH and Honorary Senior Lecturer at UCL Infection & Immunity, said: “The INHALE team are very proud to have been able to so rapidly adapt the paused INHALE clinical trial to deliver vital clinical results to frontline ICU clinicians in an hour by repurposing our testing equipment and infrastructures - with UCLH’s doctors in particular taking the lead in a record time to implementation. And what's more - we've put in analyses that will tell us what this might mean in terms of patient benefit.
