Early molecular markers of ventilator-associated pneumonia in bronchoalveolar lavage in preterm infants

Autores de IIS La Fe

• Alejandro Pinilla González

  Autor

• Inmaculada Lara Cantón

  Autor

• Laura Torrejón Rodríguez

  Autor

• Anna Parra Llorca

  Autor

• Marta Aguar Carrascosa

  Autor

• Julia Kuligowski

  Autor

• Jose David Piñeiro Ramos

  Autor

• Ángel Sánchez Illana

  Autor

• Ana Gimeno Navarro

  Autor

• Máximo Vento Torres

  Autor

• María Cernada Badía

  Autor

Grupos

• Perinatología

Abstract

Introduction Ventilator-associated pneumonia (VAP) constitutes a serious nosocomial infection. Our aim was to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in bronchoalveolar lavage fluid (BALF) and tracheal aspirates (TA) as early biomarkers of VAP in preterm infants. Methods Two cohorts were enrolled, one to select candidates and the other for validation. In both, we included preterms with suspected VAP, according to BALF culture, they were classified into confirmed VAP and no VAP. Concentration of 16 cytokines and 8 oxidative stress/inflammation biomarkers in BALF and TA was determined in all patients. Results In the first batch, IL-17A and TNF-alpha in BALF, and in the second one IL-10, IL-6, and TNF-alpha in BALF were significantly higher in VAP patients. BALF TNF-alpha AUC in both cohorts was 0.86 (sensitivity 0.83, specificity 0.88). No cytokine was shown to be predictive of VAP in TA. A statistically significant increase in the VAP group was found for glutathione sulfonamide (GSA) in BALF and TA. Conclusions TNF-alpha in BALF and GSA in BALF and TA were associated with VAP in preterm newborns; thus, they could be used as early biomarkers of VAP. Further studies with an increased number of patients are needed to confirm these results. Impact We found that TNF-alpha BALF and GSA in both BALF and TA are capable of discriminating preterm infants with VAP from those with pulmonary pathology without infection. This is the first study in preterm infants aiming to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in BALF and TA as early diagnostic markers of VAP. We have validated these results in two independent cohorts of patients. Previously studies have focused on full-term neonates and toddlers and determined biomarkers mostly in TA, but none was exclusively conducted in preterm infants.

Keywords

• ANTIBIOTIC-THERAPY; TRACHEAL ASPIRATE; CYTOKINE LEVELS; INTERLEUKIN-6; FLUID; BIOMARKERS; IMPACT; ALPHA; SERUM; STORM