Abstract

Objectives: In cystic fibrosis (CF), Pseudomonas aeruginosa (PA) is an important respiratory pathogen. Routine microbial surveillance is time-consuming and requires expectorated sputum. Volatile organic compounds (VOCs) in exhaled breath may be indicative of PA colonization. We aimed to 1) identify VOCs associated with PA in literature and 2) perform targeted exhaled breath analysis to recognize PA positive CF patients non-invasively. Methods: This study consisted of 1) a literature review for VOC targeting, and 2) a cross-sectional CF-study. Definitions used: A) PA positive, PA culture at visit/chronically; B) PA free, no PA culture in ≥12 months. Exhaled VOCs were identified via quadrupole MS. The primary endpoint was the area under the receiver operating characteristics curve (AUROCC) of individual VOCs and VOCs combined in a multi-variate regression model. Results: 241 VOCs were identified in literature of which 56 were further evaluated and 13 could be detected in exhaled breath. Exhaled breath of 25 pediatric and 28 adult CF patients, PA positive (n=16) and free (n=28) was available. 3 VOCs were significantly different (p Conclusion: Targeted VOC analysis based on published data appears to discriminate children with and without PA culture, composite VOC fingerprints appear to discriminate adults. These data merit further validation of breath analysis as alternative for pathogen detection. This work is supported by the Institut Merieux and the UK CF Trust.

Highlights

  • Cystic fibrosis (CF) is a recessively inherited, progressive multiorgan disease that results in infection of the respiratory tract by pathogens such as Pseudomonas aeruginosa (PA)

  • Eradication of PA should be initiated swiftly, but monitoring of colonisation is based on microbial sputum cultures, which frequently cannot be obtained in young cystic fibrosis (CF) patients

  • Cultures of Haemophilus influenza and Staphylococcus aureus were more prevalent in children, whereas other cultures were less prevalent in children (Table S11). 13 adults and 15 children were classified as PA

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Summary

Introduction

Cystic fibrosis (CF) is a recessively inherited, progressive multiorgan disease that results in infection of the respiratory tract by pathogens such as Pseudomonas aeruginosa (PA). The result of sputum cultures take one week and lack in sensitivity, delaying prompt treatment of infections [8,9]. Exhaled breath analysis provides a non-invasive alternative for microbial cultures. Volatile organic compounds (VOCs) in exhaled breath originate from different processes: 1) host metabolism in the lung and elsewhere, 2) microbial metabolism and 3) foreign sources such as contamination via inhaled air or the oropharynx [10]. We aimed to identify VOCs associated with PA in literature and perform targeted exhaled breath analysis to recognize PA positive CF patients non-invasively

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