Polymerase chain reaction assay for the detection of Acinetobacter baumannii in endotracheal aspirates from patients in the intensive care unit.

BACKGROUND We aim to evaluate the efficacy of polymerase chain reaction (PCR) to detect Acinetobacter baumannii in endotracheal aspirates. METHODS Endotracheal aspirates and clinical data were collected from patients who were admitted to the intensive care unit of Taipei Veterans General Hospital between April 1 and August 31 in 2006. Bacterial isolates from endotracheal aspirate cultures were phenotypically identified as Acinetobacter calcoaceticus-A baumannii complex using the API ID 32GN system. The presence of A baumannii in the aspirate was also directly detected by multiplex PCR. RESULTS Ten of the 114 endotracheal aspirate cultures were positive for A calcoaceticus-A baumannii complex, and only nine of the isolates were confirmed as A baumannii by the multiplex PCR. Direct PCR detection showed that 40 (35.1%) of the endotracheal aspirates were positive for A baumannii. Using positive culture of A baumannii as the gold standard, the sensitivity of direct PCR detection was 100% (6 of 6), the specificity was 70.4% (38 of 54), the positive predictive value was 27.3% (6 of 22), and the negative predictive value (NPV) was 100% (38 of 38) among patients with A baumannii pneumonia. Among patients with A baumannii colonization, the sensitivity of direct PCR detection was 100% (3 of 3), the specificity was 70.6% (36 of 51), the positive predictive value was 16.7% (3 of 18), and the NPV was 100% (36 of 36). CONCLUSION Direct PCR detection of A baumannii in endotracheal aspirates has a high sensitivity and NPV as compared with culture-based methods. Further studies are needed to determine the clinical applicability of this rapid detection test.