Clinical efficacy of metagenomic next-generation sequencing for the detection of pathogens in peritoneal dialysis-related peritonitis: a prospective cohort study.
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引用次数: 0
Abstract
Background: Metagenomic next-generation sequencing (mNGS) has been reported to improve pathogen identification in infectious diseases. This prospective cohort study aimed to explore the etiological diagnostic value of mNGS in peritoneal dialysis (PD)-related peritonitis.
Methods: Patients with PD-related peritonitis were consecutively recruited at the Nephrology Department of Nanjing Drum Tower Hospital. PD effluent samples for mNGS and culture were collected simultaneously. The positive rate, detection time, and consistency of mNGS and culture were compared.
Results: From August 1, 2021 to August 31, 2022, 38 patients with 41 episodes of PD-related peritonitis were enrolled. The positive rate of mNGS was higher than that of culture, although not statistically significant (92.7% vs 78.0%, P = 0.109). The average reporting time of mNGS was significantly shorter than that of culture (30.4 ± 10.5 vs 86.9 ± 22.2 h, P < 0.001). mNGS identified more co-pathogens and unusual pathogens than culture, with multiple pathogens being detected in nearly half of the samples. Among the 30 samples that tested positive by both methods, 27 (90%) showed completely (13 cases) or partly (14 cases) matched results between mNGS and culture. Fourteen patients (with 14 episodes of peritonitis) had used antibiotics within 2 weeks before specimen collection. Antibiotic usage led to a significant decrease in the culture-positive rate (57.1% vs 88.9%, P = 0.042), while the mNGS-positive rate remained unaffected (92.9% vs 92.6%, P = 1.000).
Conclusions: This study revealed that mNGS exhibited higher sensitivity and shorter reporting time compared to culture in detecting pathogens in PD-related peritonitis. For samples that yielded positive results by both methods, the consistency between mNGS and culture was substantial. mNGS may offer a novel approach for the etiological diagnosis of PD-associated peritonitis, particularly in cases involving prior antibiotic use and unusual pathogens.
背景：新一代宏基因组测序（mNGS）已被报道用于提高传染病病原体的鉴定。本前瞻性队列研究旨在探讨mNGS在腹膜透析（PD）相关性腹膜炎的病因学诊断价值。方法：连续招募南京鼓楼医院肾内科pd相关性腹膜炎患者。同时收集了mNGS和培养的PD出水样品。比较mNGS和培养的阳性率、检测时间和一致性。结果：从2021年8月1日至2022年8月31日，纳入了41例pd相关性腹膜炎的38例患者。mNGS阳性率高于培养组，但差异无统计学意义（92.7% vs 78.0%, P = 0.109）。mNGS检测pd相关性腹膜炎的平均报告时间明显短于培养（30.4±10.5 h vs 86.9±22.2 h）。结论：mNGS检测pd相关性腹膜炎的灵敏度高于培养（30.4±10.5 h），报告时间短于培养（86.9±22.2 h）。对于两种方法都产生阳性结果的样品，mNGS和培养之间的一致性是实质性的。mNGS可能为pd相关性腹膜炎的病因学诊断提供一种新的方法，特别是在既往使用抗生素和异常病原体的病例中。
期刊介绍：
European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.
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