{
  "abstract": "Introduction Current guideline-recommended antibiotic treatment durations for ventilator-associated pneumonia (VAP) are largely standardised, with limited consideration of individual patient characteristics, pathogens or clinical context. This one-size-fits-all approach risks both overtreatment—promoting antimicrobial resistance and adverse drug events—as well as undertreatment, increasing the likelihood of pneumonia recurrence and sepsis-related complications. There is a critical need for VAP-specific biomarkers to enable individualised treatment strategies. The Ventilator-associated pneumonia Biomarker Evaluation (VIBE) study aims to identify a dynamic alveolar biomarker signature associated with treatment response, with the goal of informing personalised antibiotic duration in future clinical trials.Methods and analysis VIBE is a prospective, observational, case-cohort study of 125 adult patients with VAP in Michigan Medicine University Hospital intensive care units. Study subjects will undergo non-bronchoscopic bronchoalveolar lavage on the day of VAP diagnosis (Day 1) and then on Days 3 and 5. Alveolar biomarkers (quantitative respiratory culture bioburden, alveolar neutrophil percentage and pathogen genomic load assessed via BioFire FilmArray polymerase chain reaction) will be assessed. An expert panel of intensivists, blinded to biomarker data, will adjudicate each patient’s Day 10 outcome as VAP clinical cure (control) or treatment failure (case). Absolute biomarker levels and mean-fold changes in biomarker levels will be compared between groups. Data will be used to derive a composite temporal alveolar biomarker signature predictive of VAP treatment failure.Ethics and dissemination Ethical approval was obtained from the University of Michigan Institutional Review Board (IRB #HUM00251780). Informed consent will be obtained from all study participants or their legally authorised representatives. Findings will be disseminated through peer-reviewed publications, conferences and feedback into clinical guidelines committees.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Owen Albin"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Sudha Nadimidla"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Louis Saravolatz"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Anna Barker"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Max Wayne"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Danica Rockney"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Raymond Jean"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Andrew Nguyen"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Murtaza Diwan"
    },
    {
      "affiliations": [
        "Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Virginia Pierce"
    },
    {
      "affiliations": [
        "Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Ashley Roman"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Jakob McSparron"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Robert Dickson"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Krishna Rao"
    },
    {
      "affiliations": [
        "Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA"
      ],
      "name": "Lena M Napolitano"
    },
    {
      "affiliations": [
        "Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Richard Wunderink"
    },
    {
      "affiliations": [
        "Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA"
      ],
      "name": "Keith Kaye"
    }
  ],
  "title": "Ventilator-associated pneumonia biomarker evaluation (VIBE) study: protocol for a prospective, observational, case-cohort study",
  "uid": "75b7c50f-8c6c-582e-93ef-24f51d35c122"
}