Breath analysis for in vivo detection of pathogens related to ventilator-associated pneumonia in intensive care patients: a prospective pilot study
Breath analysis for in vivo detection of pathogens related to ventilator-associated pneumonia in intensive care patients: a prospective pilot study
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DOI：
10.1088/1752-7155/9/1/016004
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发表时间：
2015-03-01
影响因子：
3.8
通讯作者：
Amann, Anton
中科院分区：
文献类型：
--
作者：
Filipiak, Wojciech;Beer, Ronny;Amann, Anton
现有的重症监护病房(ICU)机械通气(MV)患者感染的早期检测方法并不令人满意。在这里，我们提出了一项探索性研究，评估呼吸VOC分析用于非侵入性检测呼吸机患者下呼吸道病原体的可行性。一项开放的非对照临床初步研究纳入了28名机械通气(MV)患者，这些患者患有严重的颅内疾病，有可能发展为或已确诊为呼吸机相关性肺炎(VAP)。最新开发的采样技术能够在连续二氧化碳描记控制、吸附预浓缩和通过气相色谱-质谱仪(GC-MS)进行最终分析的情况下，从呼吸回路直接收集呼气，最大限度地贡献肺泡空气。最常见的微生物是金黄色葡萄球菌(5/22 VAP)、大肠埃希菌(5/22 VAP)和念珠菌。(5/22例VAP患者)。在感染金黄色葡萄球菌的VAP患者的呼气末空气中也检测到了金黄色葡萄球菌释放的代谢物。在白色念珠菌感染中也有类似的重叠(8/29个VOC)。此外，选定化合物的浓度分布与感染过程相关。这项前瞻性初步研究提供了证据，证明在临床确诊的VAP期间，呼吸机患者呼吸中病原体衍生代谢物的外观和浓度分布与特定病原体的存在相关。
Existing methods for the early detection of infections in mechanically ventilated (MV) patients at intensive care units (ICUs) are unsatisfactory. Here we present an exploratory study assessing the feasibility of breath VOC analyses for the non-invasive detection of pathogens in the lower respiratory tract of ventilated patients. An open uncontrolled clinical pilot study was performed by enrolling 28 mechanically ventilated (MV) patients with severe intracranial disease, being at risk for the development of or already with confirmed ventilation-associated pneumonia (VAP). The recently developed sampling technique enabled the collection of breath gas with a maximized contribution of alveolar air directly from the respiratory circuit under continuous capnography control, adsorptive preconcentration and final analysis by means of gas chromatography-mass spectrometry (GC-MS).VAP was confirmed in 22/28 preselected patients (78%). The most common microorganisms were Staphylococcus aureus (5/22 VAP patients), Escherichia coli (5/22 VAP patients) and Candida spp. (5/22 VAP patients). 12/32 metabolites released by S. aureus in our previous in vitro studies were also detected in the end-tidal air of VAP patients infected with this pathogen. A similar overlap was seen in Candida albicans infections (8/29 VOCs). Moreover, the concentration profile of selected compounds correlated with the course of the infection.This prospective pilot study provides proof of the concept that the appearance and the concentration profile of pathogen-derived metabolites (elucidated from in vitro experiments) in the breath of ventilated patients during clinically confirmed VAP correlates with the presence of a particular pathogen.