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Pinilla-Gonzalez A, Lara-Cantón I, Torrejón-Rodríguez L, Parra-Llorca A, Aguar M, Kuligowski J, Piñeiro-Ramos JD, Sánchez-Illana Á, Navarro AG, Vento M, Cernada M. Early molecular markers of ventilator-associated pneumonia in bronchoalveolar lavage in preterm infants. Pediatr Res 2022; 93:1559-1565. [PMID: 36071239 PMCID: PMC9451119 DOI: 10.1038/s41390-022-02271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022]
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-α in BALF, and in the second one IL-10, IL-6, and TNF-α in BALF were significantly higher in VAP patients. BALF TNF-α 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-α 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-α 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.
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Affiliation(s)
- Alejandro Pinilla-Gonzalez
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Inmaculada Lara-Cantón
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Laura Torrejón-Rodríguez
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Anna Parra-Llorca
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Marta Aguar
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Julia Kuligowski
- grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - José David Piñeiro-Ramos
- grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Ángel Sánchez-Illana
- grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain ,grid.5338.d0000 0001 2173 938XPresent Address: Analytical Chemistry Department, University of Valencia, Burjassot, Spain
| | - Ana Gimeno Navarro
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Máximo Vento
- grid.84393.350000 0001 0360 9602Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain ,grid.84393.350000 0001 0360 9602Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain ,National Coordinator of the Spanish Maternal and Infant Health and Development Network, Health Research Institute Carlos III, Spanish Ministry of Economy and Competitiveness (RD12/0026), Valencia, Spain
| | - María Cernada
- Division of Neonatology, University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain. .,Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain.
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