Journal
THORAX
Volume 72, Issue 11, Pages 1046-1048Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/thoraxjnl-2016-209065
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Funding
- Northern Ireland Health and Social Care Research and Development division
- Hospital Infection Society
- Department of Health and Wellcome Trust through the Health Innovation Challenge Fund (HICF) [0510/078]
- Sir Jules Thorn Charitable Trust [03/JTA]
- National Institute for Health Research [CL-2013-14-007] Funding Source: researchfish
- Public Health Agency [COM/4536/11] Funding Source: researchfish
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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 (C-t) 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.
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