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

Published version
Peer-reviewed

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Authors

Conway Morris, Andrew  ORCID logo  https://orcid.org/0000-0002-3211-3216
Gadsby, N 
McKenna, JP 
Hellyer, TP 
Dark, P 

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.

Description

Keywords

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

Journal Title

Thorax

Conference Name

Journal ISSN

0040-6376
1468-3296

Volume Title

Publisher

BMJ Publishing Group
Sponsorship
This study was funded by: the Northern Ireland Health and Social Care Research and Development division; the Hospital Infection Society; the Department of Health and Wellcome Trust through the Health Innovation Challenge (HIC) Fund; and the Sir Jules Thorn Charitable Trust.