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Published on: May 21, 2015
Is detection of bacterial DNA in ascitic fluid of clinical relevance?
Beate Appenrodt1, Lutz E Lehmann, Lydia Thyssen
1Departments of aInternal Medicine I, University of Bonn, Bonn, Germany. beate.appenrodt@ukb.uni-bonn.de
Background:
In patients with cirrhosis, bacterial DNA has been found in ascites reflecting bacterial translocation. However, the clinical relevance of this finding is ill-defined especially compared with the standard diagnostics for detection of spontaneous bacterial peritonitis (SBP). Furthermore, other DNA tests have not been sufficiently evaluated.
Patients And Methods:
We prospectively included 151 patients with cirrhosis and ascites admitted to our department. The patients were evaluated for diagnosis of SBP (polymorphonuclear count > 250 cells/mm) or finding of bacterascites, defined by positive bacterial culture from ascites. To detect bacterial species of bacterial DNA fragments in ascites, broad-range polymerase chain reaction and nucleotide sequencing analysis with the LightCycler SeptiFast Kit Mgrade were performed. Routine parameters were correlated with these findings.
Results:
Eighteen of 151 patients (12%) had SBP according to the classic definition. Bacterial DNA was detected in five of these 18 patients (3%), whereas in 13 patients (9%), bacterial DNA was detected without standard SBP. Seven patients (5%) had culture-positive SBP, only in two of them bacterial DNA was detected. In multivariate analysis, C-reactive protein (P = 0.000), white blood cell count (P = 0.019), and lactic acid dehydrogenase in ascites (P = 0.000) were independently associated with SBP. In the DNA-positive ascites group, none of the assessed parameters was significantly associated with the bacterial DNA positivity.
Conclusion:
We found no correlation between detection of bacterial DNA in ascites and SBP (polymorphonuclear count > 250/mm). In contrast to the patients with bacterial DNA in ascites, patients with SBP showed clinical signs of infection. This study provides no evidence that detection of bacterial DNA in ascites of patients with liver cirrhosis is of clinical or diagnostic relevance when using the panel of LightCycler SeptiFast Kit Mgrade.
Insights
Bacterial DNA in ascites of cirrhosis patients does not correlate with spontaneous bacterial peritonitis (SBP). Current DNA testing lacks clinical relevance for diagnosing SBP in these patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Bacterial translocation in cirrhosis patients leads to bacterial DNA in ascites.
- The clinical significance of detecting bacterial DNA in ascites is unclear compared to standard spontaneous bacterial peritonitis (SBP) diagnostics.
- Existing DNA detection methods require further evaluation.
Purpose of the Study:
- To investigate the clinical relevance of bacterial DNA detection in ascites of patients with liver cirrhosis.
- To compare bacterial DNA detection with standard diagnostic methods for spontaneous bacterial peritonitis (SBP).
Main Methods:
- Prospective study of 151 cirrhosis patients with ascites.
- Diagnosis of SBP based on polymorphonuclear count (>250 cells/mm³) and bacterial culture.
- Broad-range polymerase chain reaction and nucleotide sequencing (LightCycler SeptiFast Kit Mgrade) used for bacterial DNA detection in ascites.
Main Results:
- 12% of patients (18/151) had SBP by classic definition; bacterial DNA was detected in only 3% (5/18) of these.
- Bacterial DNA was found in 9% (13/151) of patients without SBP.
- No significant association was found between assessed parameters and bacterial DNA positivity in the ascites group.
Conclusions:
- No correlation exists between bacterial DNA detection in ascites and SBP diagnosis.
- Patients with SBP exhibited clinical signs of infection, unlike those with detectable bacterial DNA.
- The LightCycler SeptiFast Kit Mgrade shows no current clinical or diagnostic utility for detecting bacterial DNA in ascites of liver cirrhosis patients.
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