Hydrogen cyanide is readily detected in the headspace above Pseudomonas aeruginosa cultures and in the breath of cystic fibrosis (CF) patients with chronic (P. aeruginosa) infection. We investigated if exhaled breath HCN is an early marker of P. aeruginosa infection. 233 children with CF who were free from P. aeruginosa infection were followed for 2 years. Their median (interquartile range) age was 8.0 (5.0-12.2) years. At each study visit, an exhaled breath sample was collected for hydrogen cyanide analysis. In total, 2055 breath samples were analysed. At the end of the study, the hydrogen cyanide concentrations were compared to the results of routine microbiology surveillance. P. aeruginosa was isolated from 71 children during the study with an incidence (95% CI) of 0.19 (0.15-0.23) cases per patient-year. Using a random-effects logistic model, the estimated odds ratio (95% CI) was 3.1 (2.6-3.6), which showed that for a 1- ppbv increase in exhaled breath hydrogen cyanide, we expected a 212% increase in the odds of P. aeruginosa infection. The sensitivity and specificity were estimated at 33% and 99%, respectively. Exhaled breath hydrogen cyanide is a specific biomarker of new P. aeruginosa infection in children with CF. Its low sensitivity means that at present, hydrogen cyanide cannot be used as a screening test for this infection.

Academic Department of Child Health University Hospital of North Staffordshire Stoke on Trent UK; Institute of Science and Technology in Medicine Keele University Keele UK

Division of Child Health Obstetrics and Gynaecology School of Medicine University of Nottingham UK

Institute of Child Health Alder Hey Children's Hospital Liverpool UK

Institute of Science and Technology in Medicine Keele University Keele UK

J Heyrovský Institute of Physical Chemistry Academy of Sciences of the Czech Republic Prague Czech Republic

Manchester Adult Cystic Fibrosis Centre University Hospital of South Manchester Manchester UK

School of Computing and Mathematics Keele University Keele UK

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Recent developments and applications of selected ion flow tube mass spectrometry (SIFT-MS)

Quantification of volatile metabolites in exhaled breath by selected ion flow tube mass spectrometry, SIFT-MS