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16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia

Title: 16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia
Authors: Morris, AC
Gadsby, N
McKenna, JP
Hellyer, TP
Dark, P
Singh, S
Walsh, TS
McAuley, DF
Templeton, K
Simpson, AJ
McMullan, R
Item 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.
Issue Date: 1-Nov-2017
Date of Acceptance: 1-Oct-2016
URI: http://hdl.handle.net/10044/1/67490
DOI: https://dx.doi.org/10.1136/thoraxjnl-2016-209065
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/
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
Assisted Ventilation
Bacterial Infection
Anti-Bacterial Agents
Bronchoalveolar Lavage Fluid
Cohort Studies
Intensive Care Units
Pneumonia, Ventilator-Associated
Predictive Value of Tests
RNA, Ribosomal, 16S
Sensitivity and Specificity
United Kingdom
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2016-12-14
Appears in Collections:Department of Surgery and Cancer