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Clin Infect Dis

Title:		Microbial Volatiles as Diagnostic Biomarkers of Bacterial Lung Infection in Mechanically Ventilated Patients
Author(s):		Ahmed WM; Fenn D; White IR; Dixon B; Nijsen TME; Knobel HH; Brinkman P; van Oort PMP; Schultz MJ; Dark P; Goodacre R; Felton T; Bos LDJ; Fowler SJ; BreathDx C;
Address:		"Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and National Institute for Health Research Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom. Department of Respiratory Medicine, Amsterdam UMC-location AMC, University of Amsterdam, Amsterdam, The Netherlands. Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Center (UMC), Academic Medical Center (AMC), Amsterdam, The Netherlands. Laboratory for Environmental and Life Science, University of Nova Gorica, Nova Gorica, Slovenia. Philips Research, Philips BV, Eindhoven, The Netherlands. Eurofins Materials Science Netherlands BV, High Tech Campus, Eindhoven, The Netherlands. Department of Anaesthesiology, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands. Intensive Care, Amsterdam UMC Location AMC, Amsterdam, The Netherlands. Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand. Department of Clinical Affairs, Hamilton Medical AG, Chur, Switzerland. Critical Care Unit, Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Group, Manchester, United Kingdom. Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom"
Journal Title:		Clin Infect Dis
Year:		2023
Volume:		76
Issue:		6
Page Number:		1059 - 1066
DOI:		10.1093/cid/ciac859
ISSN/ISBN:		1537-6591 (Electronic) 1058-4838 (Print) 1058-4838 (Linking)
Abstract:		"BACKGROUND: Early and accurate recognition of respiratory pathogens is crucial to prevent increased risk of mortality in critically ill patients. Microbial-derived volatile organic compounds (mVOCs) in exhaled breath could be used as noninvasive biomarkers of infection to support clinical diagnosis. METHODS: In this study, we investigated the diagnostic potential of in vitro-confirmed mVOCs in the exhaled breath of patients under mechanical ventilation from the BreathDx study. Samples were analyzed by thermal desorption-gas chromatography-mass spectrometry. RESULTS: Pathogens from bronchoalveolar lavage (BAL) cultures were identified in 45 of 89 patients and Staphylococcus aureus was the most commonly identified pathogen (n = 15). Of 19 mVOCs detected in the in vitro culture headspace of 4 common respiratory pathogens (S. aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli), 14 were found in exhaled breath samples. Higher concentrations of 2 mVOCs were found in the exhaled breath of patients infected with S. aureus compared to those without (3-methylbutanal: P < .01, area under the receiver operating characteristic curve [AUROC] = 0.81-0.87; and 3-methylbutanoic acid: P = .01, AUROC = 0.79-0.80). In addition, bacteria identified from BAL cultures that are known to metabolize tryptophan (E. coli, Klebsiella oxytoca, and Haemophilus influenzae) were grouped and found to produce higher concentrations of indole compared to breath samples with culture-negative (P = .034) and other pathogen-positive (P = .049) samples. CONCLUSIONS: This study demonstrates the capability of using mVOCs to detect the presence of specific pathogen groups with potential to support clinical diagnosis. Although not all mVOCs were found in patient samples within this small pilot study, further targeted and qualitative investigation is warranted using multicenter clinical studies"
Keywords:		"Humans Respiration, Artificial Staphylococcus aureus Escherichia coli Pilot Projects *Pneumonia Lung Bacteria *Staphylococcal Infections/diagnosis *Volatile Organic Compounds/analysis Biomarkers/analysis exhaled volatile organic compounds gas chromatograp;"
Notes:		"MedlineAhmed, Waqar M Fenn, Dominic White, Iain R Dixon, Breanna Nijsen, Tamara M E Knobel, Hugo H Brinkman, Paul Van Oort, Pouline M P Schultz, Marcus J Dark, Paul Goodacre, Royston Felton, Timothy Bos, Lieuwe D J Fowler, Stephen J eng DH_/Department of Health/United Kingdom Multicenter Study Research Support, Non-U.S. Gov't 2022/11/01 Clin Infect Dis. 2023 Mar 21; 76(6):1059-1066. doi: 10.1093/cid/ciac859"