Detection of infection and microbial colonization in critically ill patients: a molecular approach
Detection of infection and microbial colonization in critically ill patients: a molecular approach
Infections are common in intensive care units (ICUs). Doctors often start antibiotic treatment, but determining the right time to stop is difficult. We studied whether a circulating marker called procalcitonin (PCT) can help doctors to stop antibiotic treatment sooner and whether this affects the emergence of antibiotic resistance. In Dutch ICUs, the use of PCT as a biomarker for infection safely shortened antibiotic use and did not increase the chance that patients would carry resistant bacteria in the time period around their ICU stay. This approach also appears to offer good value for money, despite the PCT test being more expensive compared to other tests with lower accuracy.
This thesis of Arezoo Shajiei-Schotsman also addresses the fungi and bacteria in the lungs of very ill patients that need breathing machines. Using DNA-based methods alongside regular culturing, we observed that each patient’s microbial lung community is unique. Yeasts, such as Candida were common, and we obtained evidence suggesting that microbes from the mouth can move into the lower airways. In lungs, removed during transplantation or cancer surgery, we noticed differences in identified microorganisms in different lung regions and for different diseases. Importantly, DNA-based detection methods identified organisms often missed by regular diagnostic culture-based detection methods.
Overall, the presented data support two ideas: PCT screening can help to reduce the unnecessary use of antibiotics, and using DNA‑based tests together with standard methods can give a clearer picture of the microorganisms present in the lungs of mechanically ventilated patients or patients with lung diseases.