Abstract
ObjectivesNew point of care diagnostics are urgently needed to reduce the over-prescription of antimicrobials for bacterial respiratory tract infection (RTI). We performed a pilot cross sectional study to assess the feasibility of gas-capillary column ion mobility spectrometer (GC-IMS), for the analysis of volatile organic compounds (VOC) in exhaled breath to diagnose bacterial RTI in hospital inpatients.Methods71 patients were prospectively recruited from the Acute Medical Unit of the Royal Liverpool University Hospital between March and May 2016 and classified as confirmed or probable bacterial or viral RTI on the basis of microbiologic, biochemical and radiologic testing. Breath samples were collected at the patient’s bedside directly into the electronic nose device, which recorded a VOC spectrum for each sample. Sparse principal component analysis and sparse logistic regression were used to develop a diagnostic model to classify VOC spectra as being caused by bacterial or non-bacterial RTI.ResultsSummary area under the receiver operator characteristic curve was 0.73 (95% CI 0.61–0.86), summary sensitivity and specificity were 62% (95% CI 41–80%) and 80% (95% CI 64–91%) respectively (p = 0.00147).ConclusionsGC-IMS analysis of exhaled VOC for the diagnosis of bacterial RTI shows promise in this pilot study and further trials are warranted to assess this technique.
Highlights
Antimicrobial resistance continues to increase, adversely affecting mortality and morbidity
71 patients were prospectively recruited from the Acute Medical Unit of the Royal Liverpool University Hospital between March and May 2016 and classified as confirmed or probable bacterial or viral respiratory tract infection (RTI) on the basis of microbiologic, biochemical and radiologic testing
There is a pressing need for novel point-of-care (POC) in-vitro diagnostics to reduce the over prescription of antimicrobials in respiratory tract infection (RTI) in primary care
Summary
Antimicrobial resistance continues to increase, adversely affecting mortality and morbidity. A major risk factor remains large volume antibiotic prescribing in primary and secondary care [1] and the rise of transmissible genetic elements encoding resistance to last-line antimicrobials raises the real possibility of a post-antibiotic era[2]. Respiratory tract infection remains a major cause of mortality and morbidity worldwide[3] and is a driver of antimicrobial prescription. In primary care these infections are often viral and self-limiting and antimicrobial prescription is not necessary. It is estimated that of the 40 million antimicrobial prescriptions issued annually for RTI in the United States, 23 million are unnecessary [4]. There is a pressing need for novel point-of-care (POC) in-vitro diagnostics to reduce the over prescription of antimicrobials in respiratory tract infection (RTI) in primary care
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