Rapid detection of pathogens of peritoneal dialysis-related peritonitis, especially in patients who have taken antibiotics, using metagenomic next-generation sequencing: a pilot study

Sasa Nie; Qingtao Zhang; Rong Chen; Li Lin; Zhenzhen Li; Yanli Sun; Jing Huang; Zhe Feng; Xueying Cao; Kun Ye; Li Tang; Jianhui Zhou; Guangyan Cai; Xiangmei Chen

doi:10.1080/0886022X.2023.2284229

Rapid detection of pathogens of peritoneal dialysis-related peritonitis, especially in patients who have taken antibiotics, using metagenomic next-generation sequencing: a pilot study

Ren Fail. 2023;45(2):2284229. doi: 10.1080/0886022X.2023.2284229. Epub 2023 Nov 29.

Authors

Sasa Nie¹, Qingtao Zhang¹, Rong Chen², Li Lin¹, Zhenzhen Li¹, Yanli Sun¹, Jing Huang¹, Zhe Feng¹, Xueying Cao¹, Kun Ye², Li Tang¹, Jianhui Zhou¹, Guangyan Cai¹, Xiangmei Chen¹

Affiliations

¹ Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.
² Department of clinical laboratory, Chinese PLA General Hospital, Beijing, China.

Abstract

Introduction: Peritoneal dialysis (PD)-related peritonitis is a serious complication of PD. Improving the diagnostic rate of peritonitis pathogens may substantially benefit peritonitis patients.

Methods: The study was conducted in the People's Liberation Army (PLA) General Hospital from 1 June 2021 to 31 May 2022. Information about peritonitis, culture and metagenomic next-generation sequencing (mNGS) results and so on were collected. Patients were divided into antibiotic-use and antibiotic-free groups. The culture and mNGS results were compared using the paired χ2 test.

Results: Data from 26 patients with peritonitis were collected. 50% of the patients had used antibiotics before samples were obtained (antibiotic-use group). The positivity rate using culture was 92.3% (12 cases) in the antibiotic-free group and 38.5% (5 cases) in the antibiotic-use group (p = 0.011). However, the positivity rate using mNGS was 92.3% (12 cases) regardless of whether antibiotics were used (p = 1.000). After revising the mNGS results, the positivity rate was 84.6% (11 cases) in both groups (p = 1.000). A significant difference between culture and mNGS results of all groups was observed (p = 0.039). The difference no matter between culture and mNGS (p = 0.016) or between culture and modified mNGS (p = 0.031) of the antibiotic-use group was observed.

Conclusion: For patients with PD-related peritonitis who previously received antibiotics, mNGS is suggested. For other patients, mNGS testing can be performed, but the results should be interpreted with caution. Much more research should be done to identify a powerful and ideal tool to detect pathogens underlying PD-related peritonitis.

Keywords: Peritoneal dialysis (PD)-related peritonitis; antibiotic; culture; metagenomic next-generation sequencing (mNGS); pathogen.

MeSH terms

Anti-Bacterial Agents / therapeutic use
High-Throughput Nucleotide Sequencing
Humans
Peritoneal Dialysis* / adverse effects
Peritonitis* / diagnosis
Peritonitis* / etiology
Pilot Projects
Sensitivity and Specificity

Substances

Anti-Bacterial Agents

Grants and funding

This study was supported by the National Natural Science Foundation of China [81670694], the China National Key R&D Program during the 13th Five-year Plan Period [2016YFC1103004], the Provincial or Ministry level project [2018MND102031], the Prevention and control of major diseases and disasters and public safety special project [2021YFC3002203]. The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of this paper.