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

Andrew Conway Morris; Naomi Gadsby; James P McKenna; Thomas P Hellyer; Paul Dark; Suveer Singh; Timothy S Walsh; Danny F McAuley; Kate Templeton; A John Simpson; Ronan McMullan

doi:10.1136/thoraxjnl-2016-209065

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

Andrew Conway Morris, Naomi Gadsby, James P McKenna, Thomas P Hellyer, Paul Dark, Suveer Singh, Timothy S Walsh, Danny F McAuley, Kate Templeton, A John Simpson, Ronan McMullan

Research output: Contribution to journal › Article › peer-review

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 >10(4) 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.

Original language	English
Journal	Thorax
Early online date	14 Dec 2016
DOIs	https://doi.org/10.1136/thoraxjnl-2016-209065
Publication status	E-pub ahead of print - 14 Dec 2016

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10.1136/thoraxjnl-2016-209065

Walsh T 16S pan-bacterial..
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@article{05bcb96cc0d64482a39eb6886adedac3,

title = "16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia",

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 >10(4) 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.",

author = "{Conway Morris}, Andrew and Naomi Gadsby and McKenna, {James P} and Hellyer, {Thomas P} and Paul Dark and Suveer Singh and Walsh, {Timothy S} and McAuley, {Danny F} and Kate Templeton and Simpson, {A John} and Ronan McMullan",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.",

year = "2016",

month = dec,

day = "14",

doi = "10.1136/thoraxjnl-2016-209065",

language = "English",

journal = "Thorax",

issn = "0040-6376",

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T1 - 16S pan-bacterial PCR can accurately identify patients with ventilator-associated pneumonia

AU - Conway Morris, Andrew

AU - Gadsby, Naomi

AU - McKenna, James P

AU - Hellyer, Thomas P

AU - Dark, Paul

AU - Singh, Suveer

AU - Walsh, Timothy S

AU - McAuley, Danny F

AU - Templeton, Kate

AU - Simpson, A John

AU - McMullan, Ronan

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2016/12/14

Y1 - 2016/12/14

N2 - 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 >10(4) 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.

AB - 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 >10(4) 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.

U2 - 10.1136/thoraxjnl-2016-209065

DO - 10.1136/thoraxjnl-2016-209065

M3 - Article

C2 - 27974525

SN - 0040-6376

JO - Thorax

JF - Thorax

ER -

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

Abstract

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