Breath Analysis of COVID-19 Patients in a Tertiary UK Hospital by Optical Spectrometry: The E-Nose CoVal Study.

Throughout the SARS-CoV-2 pandemic, diagnostic technology played a crucial role in managing outbreaks on a national and global level. One diagnostic modality that has shown promise is breath analysis, due to its non-invasive nature and ability to give a rapid result. In this study, a portable FTIR (Fourier Transform Infra-Red) spectrometer was used to detect chemical components in the breath from Covid positive symptomatic and asymptomatic patients versus a control cohort of Covid negative patients. Eighty-five patients who had a nasopharyngeal polymerase chain reaction (PCR) test for the detection of SARS-CoV-2 within the last 5 days were recruited to the study (36 symptomatic PCR positive, 23 asymptomatic PCR positive and 26 asymptomatic PCR negative). Data analysis indicated significant difference between the groups, with SARS-CoV-2 present on PCR versus the negative PCR control group producing an area under the curve (AUC) of 0.87. Similar results were obtained comparing symptomatic versus control and asymptomatic versus control. The asymptomatic results were higher than the symptomatic (0.88 vs. 0.80 AUC). When analysing individual chemicals, we found ethanol, methanol and acetaldehyde were the most important, with higher concentrations in the COVID-19 group, with symptomatic patients being higher than asymptomatic patients. This study has shown that breath analysis can provide significant results that distinguish patients with or without COVID-19 disease/carriage.

Analysis of the management of ventriculitis cases at a UK neurosurgery centre.

Background: Ventriculitis is an infection of the ventricular system of the central nervous system associated with neurosurgery and/or indwelling medical devices mainly caused by coagulase-negative staphylococci and increasingly by Gram-negative bacilli and other Gram-positive bacteria. The Infectious Diseases Society of America (IDSA) and the neurosurgery department University Hospital Coventry and Warwickshire (UHCW) have treatment guidelines for ventriculitis which recommend antimicrobials and device removal. Methods: Data on ventriculitis cases, their management and outcomes were collected from electronic laboratory and hospital records as well as patients' paper records from 2009 to 2019. Cases included patients with CSF shunts or external ventricular drainage. The management of the cases was then compared to both Infectious Diseases Society of America (IDSA) and UHCW guidelines. The data collected included the causative organisms and the use of inappropriate antimicrobials. The cost of inappropriate antimicrobials was calculated. Results: 99 patients with microbiologically confirmed ventriculitis were identified. Some cases had multiple devices and the total number of devices was 105.98% of cases had medical device removal as part of their care. Only 50% and 56% of cases had antimicrobial treatment which was compliant with local (UHCW) and IDSA guidelines, respectively. The most frequently inappropriate antimicrobials used were meropenem and linezolid, at an estimated cost of £201,172 over 10 years. The most frequently isolated organisms were coagulase negative staphylococci. Mortality rate was estimated at 14% of cases. Conclusions: We report the first analysis of the management of ventriculitis cases at UHCW over a 10-year period and demonstrate the importance of antimicrobial stewardship. We also report the local epidemiology of causes of ventriculitis at UHCW which will guide the empirical treatment of ventriculitis at UHCW.