Metagenomics for the microbiological diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP) in intensive care unit (ICU): a proof-of-concept study

Abstract

Background Hospital-acquired and ventilator-associated-pneumonia (HAP/VAP) are one of the most prevalent health-care associated infections in the intensive care unit (ICU). Culture-independent methods were therefore developed to provide faster route to diagnosis and treatment. Among these, metagenomic next-generation sequencing (mNGS) has shown considerable promise. Methods This proof-of-concept study describes the technical feasibility and evaluates the clinical validity of the mNGS for the detection and characterization of the etiologic agents causing hospital-acquired and ventilator-associated pneumonia. We performed a prospective study of all patients with HAP/VAP hospitalized in our intensive care unit for whom a bronchoalveolar lavage (BAL) was performed between July 2017 and November 2018. We compared BAL fluid culture and mNGS results of these patients. Results A total of 32 BAL fluids were fully analyzed. Of these, 22 (69%) were positive by culture and all pathogens identified were also reported by mNGS. Among the culture-positive BAL samples, additional bacterial species were revealed by mNGS for 12 patients, raising the issue of their pathogenic role (colonization versus coinfection). Among BALF with culture-negative test, 5 were positive in mNGS test. Conclusions This study revealed concordant results for pneumonia panel pathogens between mNGS and culture-positive tests and identified additional pathogens potentially implicated in pneumonia without etiologic diagnosis by culture. mNGS has emerged as a promising methodology for infectious disease diagnoses to support conventional methods. Prospective studies with real-time mNGS are warranted to examine the impact on antimicrobial decision-making and clinical outcome.

Understanding and Practices of Oral Hygiene in the Intensive Care Units: Perspectives of Medical Staff at Two University Hospital Centers

“…Oral care is not just about maintaining oral health; it plays a significant role in preventing the progression of severe complications in critically ill patients. One of the primary concerns in ICUs is the risk of nosocomial infections, particularly hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which are notorious for causing significant morbidity and mortality among this vulnerable population ( 3 , 4 ). The mortality rate associated with these conditions can reach as high as 13%, highlighting the grave implications of these infections ( 3 ).…”

“…One of the primary concerns in ICUs is the risk of nosocomial infections, particularly hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which are notorious for causing significant morbidity and mortality among this vulnerable population ( 3 , 4 ). The mortality rate associated with these conditions can reach as high as 13%, highlighting the grave implications of these infections ( 3 ). Moreover, the incidence of VAP varies significantly, leading to severe adverse outcomes for patients, including increased mortality, financial burden, and extended hospital stays ( 5 - 7 ).…”