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Original Research: Critical Care |

A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated PneumoniaEarly Diagnosis of Ventilator-Associated Pneumonia

Addison K. May, MD; Jacob S. Brady, BA; Joann Romano-Keeler, MD; Wonder P. Drake, MD; Patrick R. Norris, PhD; Judith M. Jenkins, MSN; Richard J. Isaacs, PhD; Erik M. Boczko, PhD
Author and Funding Information

From the Division of Trauma and Surgical Critical Care (Drs May and Norris, Mr Brady, and Ms Jenkins), Division of Neonatology (Dr Romano-Keeler), and Department of Pathology, Microbiology, and Immunology (Dr Drake), Vanderbilt University, Nashville, TN; Molecular Sensing Inc (Dr Isaacs), Nashville, TN; and Department of Mathematics (Dr Boczko), Ohio University, Athens, OH.

CORRESPONDENCE TO: Addison K. May, MD, Division of Trauma and Surgical Critical Care, Vanderbilt University, 1211 21st Ave S, 404 MAB, Nashville, TN 37212; e-mail: addison.may@vanderbilt.edu


FOR EDITORIAL COMMENT SEE PAGE 1448

FUNDING/SUPPORT: This study was partially supported by the Vanderbilt Institute for Clinical and Translational Research [Grant CTSA 1 UL1 RR024975].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1494-1502. doi:10.1378/chest.14-1687
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BACKGROUND:  Ventilator-associated pneumonia (VAP) remains a common complication in critically ill surgical patients, and its diagnosis remains problematic. Exhaled breath contains aerosolized droplets that reflect the lung microbiota. We hypothesized that exhaled breath condensate fluid (EBCF) in hygroscopic condenser humidifier/heat and moisture exchanger (HCH/HME) filters would contain bacterial DNA that qualitatively and quantitatively correlate with pathogens isolated from quantitative BAL samples obtained for clinical suspicion of pneumonia.

METHODS:  Forty-eight adult patients who were mechanically ventilated and undergoing quantitative BAL (n = 51) for suspected pneumonia in the surgical ICU were enrolled. Per protocol, patients fulfilling VAP clinical criteria undergo quantitative BAL bacterial culture. Immediately prior to BAL, time-matched HCH/HME filters were collected for study of EBCF by real-time polymerase chain reaction. Additionally, convenience samples of serially collected filters in patients with BAL-diagnosed VAP were analyzed.

RESULTS:  Forty-nine of 51 time-matched EBCF/BAL fluid samples were fully concordant (concordance > 95% by κ statistic) relative to identified pathogens and strongly correlated with clinical cultures. Regression analysis of quantitative bacterial DNA in paired samples revealed a statistically significant positive correlation (r = 0.85). In a convenience sample, qualitative and quantitative polymerase chain reaction analysis of serial HCH/HME samples for bacterial DNA demonstrated an increase in load that preceded the suspicion of pneumonia.

CONCLUSIONS:  Bacterial DNA within EBCF demonstrates a high correlation with BAL fluid and clinical cultures. Bacterial DNA within EBCF increases prior to the suspicion of pneumonia. Further study of this novel approach may allow development of a noninvasive tool for the early diagnosis of VAP.

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