Rapid Automated Microscopy for Microbiological Surveillance of Ventilator-associated Pneumonia

Douglas, Ivor S.; Price, Connie S.; Overdier, Katherine H.; Wolken, Robert; Metzger, Steven; Hance, Kenneth R.; Howson, David C.

doi:10.1164/rccm.201408-1468oc

Cited by 48 publications

(35 citation statements)

References 24 publications

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“…The assay has been demonstrated to be successful at both pathogen identification and antimicrobial susceptibility assessment from blood culture 101 . Further preliminary tests indicate that this system is capable of direct detection of pathogens from patient blood, urine, and sputum samples 100,102,103 . The phenotypic measures used for pathogen identification are not precise, but the system is also amenable to process samples for species identification methods such as FISH.…”

Section: Real-time Microscopy Systems For Astmentioning

confidence: 98%

New and developing diagnostic technologies for urinary tract infections

et al. 2017

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Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Urine culture with antimicrobial susceptibility testing takes 2 3 days and requires a clinical laboratory. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs. In addition to improved antimicrobial stewardship and the development of new antimicrobials, novel diagnostics are needed for timely microbial identification and determination of antimicrobial susceptibilities. New diagnostic platforms, including nucleic acid tests and mass spectrometry, have been approved for clinical use and have improved the speed and accuracy of pathogen identification from primary cultures. Optimization for direct urine testing would reduce the time to diagnosis, yet these technologies do not provide comprehensive information on antimicrobial susceptibility. Emerging technologies including biosensors, microfluidics, and other integrated platforms could improve UTI diagnosis via direct pathogen detection from urine samples, rapid antimicrobial susceptibility testing, and point-of-care testing. Successful development and implementation of these technologies has the potential to usher in an era of precision medicine to improve patient care and public health.

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Section: Real-time Microscopy Systems For Astmentioning

confidence: 98%

New and developing diagnostic technologies for urinary tract infections

et al. 2017

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“…Inaccurate diagnosis or inappropriate antimicrobial therapy, including the treatment of tracheobronchial colonisation, should be avoided. In time, newer technology may allow us to diagnose VAT and VAP in more sophisticated ways (Douglas IS, 2015;Bos LD, 2014), and determine which patients may be at an increased risk of progression from VAT to VAP based on immunological factors. This may enable targeted therapy towards those patients with VAT at the greatest risk of progression to VAP, with improved survival and a minimal excess use of antimicrobials.…”

Section: Discussionmentioning

confidence: 99%

23rd International Symposium on Infections in the Critically Ill Patient

et al. 2018

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IntroductionThis 23rd International Symposium on Infections in the Critically Ill Patient aims to review current concepts, technology and present advances in infections in critically ill patient.Sepsis, Pulmonary Infections and their therapeutic and preventive strategies will be the topics presented by international experts who will review and update sepsis as a global international problem. New guidelines of Surviving Sepsis campaign, fluid therapy and vassopressors, a balance view between personalization and protocol treatment and new recommendations for the design of future randomized control trials are provided. The immune response and the emerging methods to personalize sepsis care including new biomarkers and immunomonitoring of patients with sepsis represent a new complementary view to treat patients with severe infections and organ failure in addition to early antibiotic and the control of source of infection.New ways to treat pulmonary infections including the new global guidelines and the international actions against multiresistant microorganisms and the development of new antibiotics represent key factors to improve the outcome of severe infections. antibiotics, fluid resuscitation, blood pressure targets and so forth fails to account for the individualized needs of the patient. Sepsis is not a specific disease entity but an umbrella syndrome covering a range of biological phenotypes. Therapies should thus be selected and dose-adjusted accordingly, taking into account the individual host's phenotype, underlying comorbidities, and the site and source of infection. A one-size-fits-all, brain-stem, heavily protocolized approach will suit the lowest common denominator. Surely we should seek loftier ambitions based on education, an increased depth of understanding, enhanced monitoring and diagnostics, and a personalized approach incorporating evidence and clinical expertise. This concept of EBID (evidence-based individualized decision-making) is not new; indeed, it was enshrined by none other than David Sackett, a pioneer of evidence-based medicine who railed against rigid adoption of evidence: "Clinicians who fear top down cookbooks will find the advocates of evidence -based medicine joining them at the barricades". Ignacio Do We Need New Clinical Design for RCT? Jean-Louis VincentDepartment of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, BelgiumAbstract: The prospective randomized controlled trial (RCT) has been widely promoted as the only effective means of definitively proving the superiority of one intervention over another. However, in the intensive care unit (ICU) population, RCTs can be challenging to conduct, and results have rarely demonstrated beneficial effects of the intervention under investigation on outcomes. The main reason for this lack of success is the heterogeneous nature of the critically ill populations included in these studies. Ethical issues can also be a problem in the ICU as patients are frequently not able to give consent and surrogates may not be ...

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“…More recently, Douglas et al reported the use of this technology as a microbiological surveillance method for VAP in ICU patients (31). This study used 73 samples collected from 33 patients, with a reported sensitivity of 100% (7/7) and specificity of 97% (64/66) compared to conventional microbiological culture.…”

Section: Automated Microscopy As a Poct Tool For Vapmentioning

confidence: 99%

The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia

Millot¹,

Voisin²,

Loïez³

et al. 2017

Ann. Transl. Med.

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Ventilator-associated pneumonia (VAP) is a frequent issue in intensive care units (ICU), with a major impact on morbidity, mortality and cost of care. VAP diagnosis remains challenging: traditional culture-based microbiological techniques are still the gold-standard, but are too slow to enable clinicians to improve prognosis with timely antimicrobial therapy adjustment. Prolonged exposure to inappropriate antibiotics has also been shown to increase the incidence of multi-drug-resistant organisms (MDROs).Point-of-care testing (POCT) tools are diagnostic testing methods that can be used at or near the bedside, with delays ranging from a couple minutes to a few hours. The use of POCTs for VAP could allow for faster diagnosis and antimicrobial therapy adjustments. Despite uncertainty regarding their diagnostic value, C-reactive protein (CRP) and procalcitonin (PCT) can be detected using POCTs in few minutes. In VAP, CRP showed a sensitivity of 56% to 88% and specificity of 86% to 91%; PCT showed a sensitivity of 78% to 100% and a specificity between 75% and 97% using non-POCT methods. Automated microscopy could also be used in clinical ICU setting, with reported sensitivity of 100% and specificity of 97%, allowing for antibiotic susceptibility testing (AST) in less than 12 h. Multiplex polymerase chain reaction (MPCR) could allow for identification and AST approximation through the detection of drug-resistance genes in about 6 h, with reported sensitivity of 89.2% and specificity of 97.1%; although use as POCT was shown to result in test failure in about 40% of samples. Despite being at an early development stage, exhalome analysis, which allows for non-invasive fast identification, and chromogenic tests, more suited for the detection of drugresistance enzymes, are also promising techniques for POCT diagnosis of VAP.

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Rapid Automated Microscopy for Microbiological Surveillance of Ventilator-associated Pneumonia

Cited by 48 publications

References 24 publications

New and developing diagnostic technologies for urinary tract infections

New and developing diagnostic technologies for urinary tract infections

23rd International Symposium on Infections in the Critically Ill Patient

The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia

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