Clinical Value of Metagenomic Next‐Generation Sequencing in Early Diagnosis of Peritoneal Dialysis‐Associated Peritonitis: A Randomised Controlled Observational Trial

作者：A. Li, Zhijin Chen, Qianyun Deng, Caiyan Zheng, Haofei Hu, Zhiming Ye · 发表于：Nephrology · 年份：2025 · DOI：10.1111/nep.70094 · 被引用次数：3 · 研究领域：Dialysis and Renal Disease Management、Bacterial Identification and Susceptibility Testing、Sepsis Diagnosis and Treatment

AIM: While metagenomic next-generation sequencing (mNGS) is a high-throughput diagnostic tool capable of rapidly and accurately identifying pathogenic microorganisms, predicting their antibiotic resistance/susceptibility profiles, its clinical utility in peritoneal dialysis-associated peritonitis (PDAP) remains unvalidated. This study aims to evaluate its ability to enable early pathogen detection and predict antibiotic susceptibility, thereby informing optimised treatment strategies. METHOD: A prospective randomised controlled trial was conducted in patients diagnosed with PDAP. Participants were divided into two groups: (1) the culture & mNGS group (n = 78), where both conventional dialysis effluent culture and mNGS were performed, and clinicians had access to mNGS results; and (2) the only culture group (n = 76), where clinicians relied solely on culture results. All patients were examined for mNGS, but only patients in the culture & mNGS group had mNGS results that were known to their clinicians. Empirical intraperitoneal antimicrobial therapy was initiated for all patients, with subsequent regimen adjustments based on clinical judgement, culture reports, and/or mNGS findings. The study duration spanned from the initiation of anti-infective therapy to 3 months post-treatment. Outcomes included the comparative performance of culture versus mNGS, mNGS-based antimicrobial resistance prediction accuracy, and the clinical impact on treatment decisions. RESULTS: The culture & m...