16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia
Author(s)
Type
Journal Article
Abstract
Ventilator-associated pneumonia (VAP) remains a challenge to intensive care units, with secure diagnosis relying on microbiological cultures that take up to 72 hours to provide a result. We sought to derive and validate a novel, real-time 16S rRNA gene PCR for rapid exclusion of VAP. Bronchoalveolar lavage (BAL) was obtained from two independent cohorts of patients with suspected VAP. Patients were recruited in a 2-centre derivation cohort and a 12-centre confirmation cohort. Confirmed VAP was defined as growth of >104 colony forming units/ml on semiquantitative culture and compared with a 16S PCR assay. Samples were tested from 67 patients in the derivation cohort, 10 (15%) of whom had confirmed VAP. Using cycles to cross threshold (Ct) values as the result of the 16S PCR test, the area under the receiver operating characteristic (ROC) curve (AUROC) was 0.94 (95% CI 0.86 to 1.0, p<0.0001). Samples from 92 patients were available from the confirmation cohort, 26 (28%) of whom had confirmed VAP. The AUROC for Ct in this cohort was 0.89 (95% CI 0.83 to 0.95, p<0.0001). This study has derived and assessed the diagnostic accuracy of a novel application for 16S PCR. This suggests that 16S PCR in BAL could be used as a rapid test in suspected VAP and may allow better stewardship of antibiotics. Trial registration number VAPRAPID trial ref NCT01972425.
Date Issued
2017-11-01
Online Publication Date
2017-11-01
2019-03-08T15:49:36Z
Date Acceptance
2016-10-01
ISSN
1468-3296
Publisher
BMJ Publishing Group
Start Page
1046
End Page
1048
Journal / Book Title
Thorax
Volume
72
Issue
11
Copyright Statement
© 2016 The Author(s). This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Source Database
web-of-science
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000413364800012&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Respiratory System
ANTIBIOTIC USE
PREVALENCE
INFECTION
Assisted Ventilation
Bacterial Infection
Pneumonia
Anti-Bacterial Agents
Biomarkers
Bronchoalveolar Lavage Fluid
Bronchoscopy
Cohort Studies
Humans
Intensive Care Units
Pneumonia, Ventilator-Associated
Predictive Value of Tests
RNA, Ribosomal, 16S
Sensitivity and Specificity
United Kingdom
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2016-12-14