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Bacteria-derived DNA fragment in peritoneal dialysis effluent as a predictor of relapsing peritonitis
Cheuk-Chun Szeto1, Ka-Bik Lai, Bonnie Ching-Ha Kwan
1Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Background And Objectives:
Relapsing and recurrent peritonitis episodes are important causes of treatment failure in patients undergoing peritoneal dialysis (PD). This study explored whether the level of bacteria-derived DNA fragment in PD effluent predicts the development of relapsing or recurrent peritonitis.
Design, Setting, Participants, & Measurements:
The study included 143 patients with PD peritonitis in a dialysis unit between September 2010 and December 2011. Every 5 days until antibiotic treatment ended, PD effluent was collected to determine bacteria-derived DNA fragment level, which is represented by the number of PCR cycles at which bacterial DNA could be detected. Patients were followed for the development of relapsing or recurrent peritonitis.
Results:
Thirty-nine patients were excluded because of immediate treatment failure or incorrect diagnosis. Of the other 104 patients, 15 (14.4%) developed relapsing peritonitis, 3 (2.9%) had recurrent peritonitis, and 5 (4.8%) had repeat episodes. Patients with relapsing or recurrent peritonitis episodes had significantly higher levels of bacterial DNA fragment in PD effluent than those without relapsing or recurrence, both 5 days before (31.9 ± 3.4 versus 34.3 ± 3.0 cycles; P=0.002) and on the day of (32.3 ± 2.6 versus 34.1 ± 1.7 cycles; P<0.001) completion of antibiotics. When bacterial DNA fragment detectable by 34 PCR cycles 5 days before the completion of antibiotics is used as the cutoff, it has a sensitivity of 88.9% and specificity of 60.5% for the prediction of relapsing or recurrent peritonitis.
Conclusions:
Bacterial DNA fragment levels in PD effluent are significantly higher, both 5 days before and on the date of completion of antibiotics, among patients who subsequently develop relapsing or recurrent peritonitis than among those cured by antibiotics. Further studies are needed to validate these results and confirm the clinical utility of dialysate bacterial DNA fragment level.
Insights
Elevated bacterial DNA fragments in peritoneal dialysis (PD) fluid predict relapsing peritonitis. Higher DNA levels before and after antibiotic treatment indicate a higher risk of peritonitis recurrence in PD patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Molecular Diagnostics
Background:
- Relapsing and recurrent peritonitis are significant challenges in peritoneal dialysis (PD), often leading to treatment failure.
- Identifying predictors of peritonitis recurrence is crucial for improving patient outcomes in PD.
Purpose of the Study:
- To investigate whether bacteria-derived DNA fragment levels in PD effluent can predict the development of relapsing or recurrent peritonitis.
- To assess the diagnostic accuracy of bacterial DNA fragment levels for predicting peritonitis recurrence.
Main Methods:
- A prospective study involving 104 patients with PD peritonitis.
- PD effluent samples were collected every 5 days to measure bacterial DNA fragment levels using PCR.
- Patients were monitored for the development of relapsing or recurrent peritonitis following antibiotic treatment.
Main Results:
- Patients who developed relapsing or recurrent peritonitis had significantly higher bacterial DNA fragment levels in PD effluent compared to those cured.
- Elevated DNA levels were observed both 5 days before and on the day of antibiotic treatment completion.
- A cutoff of 34 PCR cycles for bacterial DNA fragment detection 5 days before antibiotic completion showed 88.9% sensitivity and 60.5% specificity for predicting recurrence.
Conclusions:
- Bacterial DNA fragment levels in PD effluent serve as a significant predictor of relapsing or recurrent peritonitis.
- Higher bacterial DNA fragment levels indicate a higher likelihood of treatment failure and recurrence in PD patients.
- Further research is warranted to validate these findings and establish the clinical utility of this diagnostic marker.
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