title: Breath analysis for in vivo detection of pathogens related to ventilator-associated pneumonia in intensive care patients: a prospective pilot study.
abstract: 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.
authors.affiliation: Breath Research Institute of the Leopold Franzens University of Innsbruck, Rathausplatz 4, A-6850 Dornbirn, Austria. Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Filipiak
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.forename: Andreas
authors.initials: A
authors.lastname: Sponring
authors.forename: Anna
authors.initials: A
authors.lastname: Filipiak
authors.forename: Clemens
authors.initials: C
authors.lastname: Ager
authors.forename: Alois
authors.initials: A
authors.lastname: Schiefecker
authors.forename: Simon
authors.initials: S
authors.lastname: Lanthaler
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.forename: Markus
authors.initials: M
authors.lastname: Nagl
authors.forename: Jakob
authors.initials: J
authors.lastname: Troppmair
authors.forename: Anton
authors.initials: A
authors.lastname: Amann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001944:Breath Tests / Q000379:methods*; D002177:Candidiasis / Q000175:diagnosis; D003422:Critical Care / Q000379:methods; D042241:Early Diagnosis; D004927:Escherichia coli Infections / Q000175:diagnosis; D005240:Feasibility Studies; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis; D055549:Volatile Organic Compounds / Q000032:analysis*; D055815:Young Adult
chemical_list: D055549:Volatile Organic Compounds