目的 探讨病原体宏基因二代测序(metagenomic next-generation sequencing，mNGS)在抗生素暴露的腹膜透析(peritoneal dialysis，PD)相关腹膜炎患者中的病原学诊断价值。 方法 回顾性分析2020年6月─2024年5月在南京大学医学院附属鼓楼医院就诊并同时留取PD流出液标本行病原体mNGS和微生物培养的PD相关腹膜炎患者的临床资料，将患者分为2周内使用抗生素组和未使用抗生素组，比较2组mNGS与微生物培养的病原体检出情况。 结果 共69例符合条件的患者进入本研究，25例有抗生素使用史。有抗生素使用史患者的微生物培养阳性率低于未使用抗生素组(χ2=20.707，P＜0.001)，mNGS阳性率未受影响(χ2=0.000，P=1.000)。根据标本留取前抗生素使用时间，将患者分为3组：使用时间≤1 d组(n=5)、2～7 d组(n=14)和≥8 d组(n=6)，3组患者PD流出液mNGS阳性率无统计学差异(χ2=1.182，P=1.000)，而微生物培养的阳性率随抗生素暴露时间延长逐渐下降(χ2=7.123，P=0.025)。在2种检测方法均阳性的47例患者中，44例(93.6%)患者mNGS和培养结果完全一致(28例)或部分一致(16例)。 结论 对于既往接受过抗生素治疗的PD相关腹膜炎患者mNGS可以显著提高病原体检出率，并与微生物培养检出的病原体有较好的一致性，有望在PD相关腹膜炎的病原学诊断和治疗指导中发挥作用。
Abstract
Objective To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) for pathogens of peritoneal dialysis (PD)-associated peritonitis following antibiotic treatment. Methods We retrospectively analyzed clinical data of the patients with PD-associated peritonitis treated in Nanjing Drum Tower Hospital between June 2020 and May 2024. PD effluents were collected from the patients for mNGS and microbial culture. They were categorized into two groups based on antibiotic use within two weeks: antibiotic exposure group and no antibiotic exposure group. Pathogen detection rates of mNGS and microbial culture were compared between the two groups. Results A total of 69 patients were recruited in this study, including 25 patients in the antibiotic exposure group. The pathogen detection rate of microbial culture was significantly lower in the antibiotic exposure group than in the no antibiotic exposure group (χ2=20.707, P＜0.001), while the rate of mNGS remained unaffected (χ2=0.000, P=1.000). Based on the duration of antibiotic use prior to PD effluent collection, patients in the antibiotic exposure group were further divided into three groups: ≤1 day (n=5), 2～7 days (n=14), and ≥8 days (n=6) groups. There was no significant difference in pathogen detection rate of mNGS among the three groups (χ2=1.182, P=1.000), whereas the rate of microbial culture decreased along with the duration of antibiotic use (χ2=7.123, P=0.025). Both mNGS and microbial culture were found to be positive in 47 patients, of which 44 patients (93.6%) had the consistently positive results between the two detection methods, including identical results in 28 cases and partial identical results in 16 cases. Conclusion For patients with PD-associated peritonitis following antibiotic treatment, mNGS has the advantages of higher pathogen detection rate and stronger consistency with the pathogens identified by microbial culture.
关键词
腹膜透析相关腹膜炎 /
病原学 /
宏基因二代测序 /
抗生素使用
Key words
Peritoneal dialysis-associated peritonitis /
Etiology /
Metagenomics next-generation sequencing /
Antibiotic exposure
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基金
南京鼓楼医院临床研究专项资金(2021-LCYJ-PY-12)；南京市卫生科技发展专项资金项目医药卫生科研课题(YKK21090)
