Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

Liapikou, Adamantia; Cillóniz, Catia

doi:10.1080/14787210.2019.1635010

Cited by 11 publications

(10 citation statements)

References 94 publications

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“…All patients were diagnosed as pulmonary infection judged by the board-certified physician on the basis of clinical manifestations and imaging examination results. 59 , 60 mNGS analysis was ordered as clinically indicated by the treating physician of patients, and informed consent was obtained from each included patient. Total 504 clinical specimens from the 452 patients were included, including Bronchoalveolar lavage fluid (BALF, n = 284), sputum (n = 97), peripheral blood (PB, n = 97), cerebrospinal fluid (CSF, n = 14), pus (n = 3), pleural fluid (PF, n = 5) and lung biopsy tissue (n = 4).…”

Section: Methodsmentioning

confidence: 99%

Profile of Bacteria with ARGs Among Real-World Samples from ICU Admission Patients with Pulmonary Infection Revealed by Metagenomic NGS

Chen¹,

Bai²,

Gao³

et al. 2021

IDR

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Background Treatment of pulmonary infections in the intensive care unit (ICU) represents a great challenge, especially infections caused by antibiotic resistance pathogens. A thorough and up-to-date knowledge of the local spectrum of antibiotic resistant bacteria can improve the antibiotic treatment efficiency. In this study, we aimed to reveal the profile of bacteria with antibiotic resistance genes (ARGs) in real-world samples from ICU admission patients with pulmonary infection in Mainland, China, by metagenomic next-generation sequencing (mNGS). Methods A total of 504 different types of clinical samples from 452 ICU admission patients with pulmonary infection were detected by mNGS analysis. Results A total of 485 samples from 434 patients got successful mNGS results. Among 434 patients, one or more bacteria with ARGs were detected in 192 patients (44.24%, 192/434), and ≥2 bacteria with ARGs were detected in 85 (19.59%, 85/434) patients. The predominant detected bacteria were Corynebacterium striatum ( C. striatum ) (11.76%, 51/434), Acinetobacter baumannii ( A. baumannii ) (11.52%, 50/434) and Enterococcus faecium ( E. faecium ) (8.99%, 39/434). ermX conferred resistance to MSL B and cmx to phenicol were the only two ARGs detected in C. striatum ; in A. baumannii , most of ARGs were resistance-nodulation-division (RND)-type efflux pumps genes, which conferred resistance to multi-drug; ermB conferred resistance to MSL B and efmA to multi-drug were the predominant ARGs in E. faecium . Bacteria with ARGs were detected in 50% (140/280) bronchoalveolar lavage fluid (BALF) and 50.5% (48/95) sputum samples, which were significantly higher than in blood and cerebrospinal fluid (CSF) samples. Conclusion High level of bacteria with ARGs was observed in clinical samples, especially BALF and sputum samples from ICU admission patients with pulmonary infection in Mainland, China. And C. striatum resistant to MSL B and/or phenicol, multi-drug resistance A. baumannii and E. faecium were the lead bacteria.

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Section: Methodsmentioning

confidence: 99%

Profile of Bacteria with ARGs Among Real-World Samples from ICU Admission Patients with Pulmonary Infection Revealed by Metagenomic NGS

Chen¹,

Bai²,

Gao³

et al. 2021

IDR

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“…A good example of the impact of RDTs on healthcare-associated infections is the integration of novel and rapid diagnostics for resistance phenotyping in patients with hospital- and ventilator-acquired pneumonia (HAP and VAP) as it can potentially significantly improve outcomes. 49 , 77 HAP is still a serious infection and an important cause of morbidity and mortality. 49 In one study, the respiFISH ® HAP Gram (−) Panel using fluorescence-DNA molecular beacons (Miacom Diagnostics) shortened identification time by 1 working day (species-level identification within 30 min) with sensitivity and specificity of 94.3% and 87.3%, respectively, relative to standard culture methods.…”

Section: The Impact Of Rdts On Patient Outcomes In Healthcare-associa...mentioning

confidence: 99%

Early appropriate diagnostics and treatment of MDR Gram-negative infections

Bassetti

Kanj

Kiratisin

et al. 2022

JAC-Antimicrobial Resistance

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The term difficult-to-treat resistance has been recently coined to identify Gram-negative bacteria exhibiting resistance to all fluoroquinolones and all β-lactam categories, including carbapenems. Such bacteria are posing serious challenges to clinicians trying to identify the best therapeutic option for any given patient. Delayed appropriate therapy has been associated with worse outcomes including increase in length of stay, increase in total in-hospital costs and ∼20% increase in the risk of in-hospital mortality. In addition, time to appropriate antibiotic therapy has been shown to be an independent predictor of 30 day mortality in patients with resistant organisms. Improving and anticipating aetiological diagnosis through optimizing not only the identification of phenotypic resistance to antibiotic classes/agents, but also the identification of specific resistance mechanisms, would have a major impact on reducing the frequency and duration of inappropriate early antibiotic therapy. In light of these considerations, the present paper reviews the increasing need for rapid diagnosis of bacterial infections and efficient laboratory workflows to confirm diagnoses and facilitate prompt de-escalation to targeted therapy, in line with antimicrobial stewardship principles. Rapid diagnostic tests currently available and future perspectives for their use are discussed. Early appropriate diagnostics and treatment of MDR Gram-negative infections require a multidisciplinary approach that includes multiple different diagnostic methods and further consensus of algorithms, protocols and guidelines to select the optimal antibiotic therapy.

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“…51 For VAP, it provides rapid identification of pathogens and main resistance mechanisms. 52,53 In cohort studies, the use of molecular methods possessed 80 to 90% of sensitivity and specificity for diagnosing responsible bacteria and resistance mechanisms. It would have led to antibiotic changes in twothirds of the patients including an earlier adequate therapy in one-fifth of the cases and a shift to a narrower spectrum antibiotic therapy in more than one-third of the cases.…”

Section: Impact On Treatment Strategiesmentioning

confidence: 99%

HAP and VAP after Guidelines

Wicky

Martín‐Loeches

Timsit

2022

Semin Respir Crit Care Med

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Nosocomial pneumonia is associated with worsened prognosis when diagnosed in intensive care unit (ICU), ranging from 12 to 48% mortality. The incidence rate of ventilation-acquired pneumonia tends to decrease below 15/1,000 intubation-day. Still, international guidelines are heterogeneous about diagnostic criteria because of inaccuracy of available methods. New entities have thus emerged concerning lower respiratory tract infection, namely ventilation-acquired tracheobronchitis (VAT), or ICU-acquired pneumonia (ICUAP), eventually requiring invasive ventilation (v-ICUAP), according to the type of ventilation support. The potential discrepancy with non-invasive methods could finally lead to underdiagnosis in almost two-thirds of non-intubated patients. Delayed diagnostic could explain in part the 2-fold increase in mortality of penumonia when invasive ventilation is initiated. Here we discuss the rationale underlying this new classification.Many situations can lead to misdiagnosis, even more when the invasive mechanical ventilation is initiated. The chest radiography lacks sntivity and specificity for diagnosing pneumonia. The place of chest computed tomography and lung ultrasonography for routine diagnostic of new plumonary infiltrate remain to be evaluated.Microbiological methods used to confirm the diagnostic can be heterogeneous. The development of molecular diagnostic tools may improve the adequacy of antimicrobial therapies of ventilated patients with pneumonia, but we need to further assess its impact in non-ventilated pneumonia.In this review we introduce distinction between hospital-acquired pneumonia according to the localization in the hospital and the oxygenation/ventilation mode. A clarification of definition is the first step to develop more accurate diagnostic strategies and to improve the patients' prognosis.

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Emerging strategies for the noninvasive diagnosis of nosocomial pneumonia

Cited by 11 publications

References 94 publications

Profile of Bacteria with ARGs Among Real-World Samples from ICU Admission Patients with Pulmonary Infection Revealed by Metagenomic NGS

Profile of Bacteria with ARGs Among Real-World Samples from ICU Admission Patients with Pulmonary Infection Revealed by Metagenomic NGS

Early appropriate diagnostics and treatment of MDR Gram-negative infections

HAP and VAP after Guidelines

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