title: Novel toxin assays implicate Mycoplasma pneumoniae in prolonged ventilator course and hypoxemia.
abstract: BACKGROUND
  Community-acquired respiratory distress syndrome (CARDS) toxin is a unique Mycoplasma pneumoniae virulence factor. Molecular assays targeting this toxin are more sensitive than existing diagnostics, but these assays have not been used to investigate the role of M pneumoniae as a nosocomial infection in critical illness. We sought to determine the incidence of M pneumoniae among mechanically ventilated subjects using these novel assays and to investigate the impact of this pathogen on pulmonary outcomes.
  
  
  METHODS
  We conducted a prospective observational study enrolling subjects with suspected ventilator-associated pneumonia (VAP) undergoing BAL in the surgical trauma ICU at a level I trauma center. Lavage fluid and serum samples were tested for M pneumoniae using assays to detect CARDS toxin gene sequences, protein, or antitoxin antibodies.
  
  
  RESULTS
  We collected samples from 37 subjects, with 41% (15 of 37) testing positive using these assays. The positive and negative groups did not differ significantly in baseline demographic characteristics, including age, sex, injury severity, or number of ventilator days before bronchoscopy. The positive group had significantly fewer ventilator-free days (P = .04) and lower average oxygenation (P = .02). These differences were most pronounced among subjects with ARDS.
  
  
  CONCLUSIONS
  Evidence is provided that M pneumoniae is present in a substantial number of subjects with suspected VAP. Subjects testing positive experience a significantly longer ventilator course and worse oxygenation compared with subjects testing negative.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Muir
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX. Electronic address: cohn@uthscsa.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Christopher
authors.initials: C
authors.lastname: Louden
authors.affiliation: Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Thirumalai R
authors.initials: TR
authors.lastname: Kannan
authors.affiliation: Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Baseman
mesh_terms: D018806:APACHE; D000704:Analysis of Variance; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D001427:Bacterial Toxins / Q000235:genetics / Q000378:metabolism*; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D003428:Cross Infection / Q000378:metabolism / Q000382:microbiology*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000378:metabolism / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity*; D011019:Pneumonia, Mycoplasma / Q000378:metabolism / Q000382:microbiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D014774:Virulence
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; C546120:CARDS toxin, Mycoplasma pneumoniae