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Lao HY, Wong LLY, Hui Y, Ng TTL, Chan CTM, Lo HWH, Yau MCY, Leung ECM, Wong RCW, Ho AYM, Yip KT, Lam JYW, Chow VCY, Luk KS, Que TL, Chow FWN, Siu GKH. The clinical utility of Nanopore 16S rRNA gene sequencing for direct bacterial identification in normally sterile body fluids. Front Microbiol 2024; 14:1324494. [PMID: 38264489 PMCID: PMC10803466 DOI: 10.3389/fmicb.2023.1324494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
The prolonged incubation period of traditional culture methods leads to a delay in diagnosing invasive infections. Nanopore 16S rRNA gene sequencing (Nanopore 16S) offers a potential rapid diagnostic approach for directly identifying bacteria in infected body fluids. To evaluate the clinical utility of Nanopore 16S, we conducted a study involving the collection and sequencing of 128 monomicrobial samples, 65 polymicrobial samples, and 20 culture-negative body fluids. To minimize classification bias, taxonomic classification was performed using 3 analysis pipelines: Epi2me, Emu, and NanoCLUST. The result was compared to the culture references. The limit of detection of Nanopore 16S was also determined using simulated bacteremic blood samples. Among the three classifiers, Emu demonstrated the highest concordance with the culture results. It correctly identified the taxon of 125 (97.7%) of the 128 monomicrobial samples, compared to 109 (85.2%) for Epi2me and 102 (79.7%) for NanoCLUST. For the 230 cultured species in the 65 polymicrobial samples, Emu correctly identified 188 (81.7%) cultured species, compared to 174 (75.7%) for Epi2me and 125 (54.3%) for NanoCLUST. Through ROC analysis on the monomicrobial samples, we determined a threshold of relative abundance at 0.058 for distinguishing potential pathogens from background in Nanopore 16S. Applying this threshold resulted in the identification of 107 (83.6%), 117 (91.4%), and 114 (91.2%) correctly detected samples for Epi2me, Emu, and NanoCLUST, respectively, in the monomicrobial samples. Nanopore 16S coupled with Epi2me could provide preliminary results within 6 h. However, the ROC analysis of polymicrobial samples exhibited a random-like performance, making it difficult to establish a threshold. The overall limit of detection for Nanopore 16S was found to be about 90 CFU/ml.
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Affiliation(s)
- Hiu-Yin Lao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Lily Lok-Yee Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Yan Hui
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Timothy Ting-Leung Ng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Chloe Toi-Mei Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Hazel Wing-Hei Lo
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Miranda Chong-Yee Yau
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | - Eddie Chi-Man Leung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | - River Chun-Wai Wong
- Department of Microbiology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Alex Yat-Man Ho
- Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong SAR, China
| | - Kam-Tong Yip
- Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China
| | - Jimmy Yiu-Wing Lam
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China
| | - Viola Chi-Ying Chow
- Department of Microbiology, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Kristine Shik Luk
- Department of Pathology, Princess Margaret Hospital, Kowloon, Hong Kong SAR, China
| | - Tak-Lun Que
- Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR, China
| | - Franklin Wang Ngai Chow
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Gilman Kit-Hang Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Lui GCY, Yip TCF, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Chan HLY, Hui DSC, Wong GLH. Significantly Lower Case-fatality Ratio of Coronavirus Disease 2019 (COVID-19) than Severe Acute Respiratory Syndrome (SARS) in Hong Kong-A Territory-Wide Cohort Study. Clin Infect Dis 2021; 72:e466-e475. [PMID: 33005933 PMCID: PMC7543259 DOI: 10.1093/cid/ciaa1187] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The case-fatality ratios (CFR) of coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) appeared to differ substantially. We aimed to compare the CFR and its predictors of COVID-19 and SARS patients using a territory-wide cohort in Hong Kong. METHODS This was a territory-wide retrospective cohort study using data captured from all public hospitals in Hong Kong. Laboratory-confirmed COVID-19 and SARS patients were identified. The primary endpoint was a composite endpoint of intensive care unit admission, use of mechanical ventilation, and/or death. RESULTS We identified 1013 COVID-19 patients (mean age, 38.4 years; 53.9% male) diagnosed from 23 January to 14 April 2020 and 1670 SARS patients (mean age, 44.4 years; 44.0% male) from March to June 2003. Fifty-five (5.4%) COVID-19 patients and 432 (25.9%) SARS patients had reached the primary endpoint in 30 days. By 30 June 2003, 286 SARS patients had died (CFR, 17.1%). By 7 June 2020, 4 COVID-19 patients had died (CFR, 0.4%). After adjusting for demographic and clinical parameters, COVID-19 was associated with a 71% lower risk of primary endpoint compared with SARS (adjusted hazard ratio, 0.29; 95% confidence interval, .21-.40; P < .0001). Age, diabetes mellitus, and laboratory parameters (high lactate dehydrogenase, high C-reactive protein, and low platelet count) were independent predictors of the primary endpoint in COVID-19 patients, whereas use of antiviral treatments was not associated with primary endpoint. CONCLUSIONS The CFR of COVID-19 was 0.4%. Age and diabetes were associated with worse outcomes, whereas antiviral treatments were not.
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Affiliation(s)
- Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Chinaand
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Chinaand
| | | | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Chinaand
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Chinaand
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Chinaand
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Yip TCF, Lui GCY, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Hui DSC, Chan HLY, Wong GLH. Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19. Gut 2021; 70:733-742. [PMID: 32641471 PMCID: PMC7371491 DOI: 10.1136/gutjnl-2020-321726] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Data on serial liver biochemistries of patients infected by different human coronaviruses (HCoVs) are lacking. The impact of liver injury on adverse clinical outcomes in coronavirus disease 2019 (COVID-19) patients remains unclear. DESIGN This was a retrospective cohort study using data from a territory-wide database in Hong Kong. COVID-19, severe acute respiratory syndrome (SARS) and other HCoV patients were identified by diagnosis codes and/or virological results. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevation was defined as ALT/AST ≥2 × upper limit of normal (ie, 80 U/L). The primary end point was a composite of intensive care unit (ICU) admission, use of invasive mechanical ventilation and/or death. RESULTS We identified 1040 COVID-19 patients (mean age 38 years, 54% men), 1670 SARS patients (mean age 44 years, 44% men) and 675 other HCoV patients (mean age 20 years, 57% men). ALT/AST elevation occurred in 50.3% SARS patients, 22.5% COVID-19 patients and 36.0% other HCoV patients. For COVID-19 patients, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation and 4 (0.4%) died. ALT/AST elevation was independently associated with primary end point (adjusted OR (aOR) 7.92, 95% CI 4.14 to 15.14, p<0.001) after adjusted for albumin, diabetes and hypertension. Use of lopinavir-ritonavir ±ribavirin + interferon beta (aOR 1.94, 95% CI 1.20 to 3.13, p=0.006) and corticosteroids (aOR 3.92, 95% CI 2.14 to 7.16, p<0.001) was independently associated with ALT/AST elevation. CONCLUSION ALT/AST elevation was common and independently associated with adverse clinical outcomes in COVID-19 patients. Use of lopinavir-ritonavir, with or without ribavirin, interferon beta and/or corticosteroids was independently associated with ALT/AST elevation.
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Affiliation(s)
- Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Viola Chi-Ying Chow
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Medical Data Analytic Centre (MDAC), Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Teoh JYC, Yip TCF, Lui GCY, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Chiu PKF, Ng CF, Hui DSC, Chan HLY, Szeto CC, Wong GLH. Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019. J Am Soc Nephrol 2021; 32:961-971. [PMID: 33483314 PMCID: PMC8017544 DOI: 10.1681/asn.2020071097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/10/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear. METHODS This retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. RESULTS We identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event. CONCLUSIONS AKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China,Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Viola Chi-Ying Chow
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China,Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
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Leung ECM, Chow VCY, Lee MKP, Lai RWM. Deep throat saliva as an alternative diagnostic specimen type for the detection of SARS-CoV-2. J Med Virol 2020; 93:533-536. [PMID: 32621616 PMCID: PMC7361401 DOI: 10.1002/jmv.26258] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 12/31/2022]
Abstract
Nasopharyngeal swabs (NPS) are widely accepted as specimens for the detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in the current pandemic of coronavirus disease 2019. However, the collection procedures for NPS specimens causes sneezing and coughing in most patients, which generate droplets or aerosol particles that are hazardous to the healthcare workers collecting these specimens. In this study, 95 patient‐matched paired deep throat saliva (DTS) and NPS specimens from 62 patients were analyzed. Samples were tested for SARS‐CoV‐2 by reverse‐transcription polymerase chain reaction (RT‐PCR). The rates of detection for DTS (53.7%) and NPS (47.4%) samples were comparable (P = .13). It is important to note that the patients should be clearly instructed or supervised during DTS collection. In conclusion, SARS‐CoV‐2 detection by RT‐PCR was equivalent in DTS and NPS specimens. This study aimed to assess the comparability of deep throat saliva (DTS) to nasopharyngeal swab (NPS) for the detection of SARS‐CoV‐2 by RT‐PCR. The results showed that SARS‐CoV‐2 detection by RT‐PCR was equivalent in DTS and NPS specimens.
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Affiliation(s)
| | | | - May Kin-Ping Lee
- Department of Microbiology, Prince of Wales Hospital, Hong Kong, China
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Chow KM, Chow VCY, Szeto CC, Law MC, Leung CB, Li PKT. Continuous ambulatory peritoneal dialysis peritonitis: broth inoculation culture versus water lysis method. Nephron Clin Pract 2007; 105:c121-5. [PMID: 17228171 DOI: 10.1159/000098643] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 11/06/2006] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND/AIM In the setting of empiric antibiotic treatment of peritoneal-dialysis-related peritonitis complications, the speed with which a bacteriological diagnosis can be achieved is of importance. We compare the clinical performance of two culture methods to diagnose the causative microorganisms as suggested by the International Society for Peritoneal Dialysis and the United Kingdom Health Protection Agency. METHODS We prospectively evaluated microbiological cultures of peritoneal fluid samples by the direct broth culture versus water lysis. Samples from 17 consecutive patients with dialysis-associated peritonitis were examined. RESULTS Of the 17 dialysates cultured, 14 (82.4%) were positive by one of the two methods. The final culture results agreed in 16 of 17 specimens (94.1%). The preliminary organism identification rate by Gram staining with the broth culture method was 70.6%, which was significantly greater than 17.6% by the water lysis method (p = 0.0019). In particular, the broth culture technique demonstrated superior Gram stain performance to identify Gram-positive organisms. Among the 13 dialysate samples positive by both methods, the broth culture method detected organisms faster than the water lysis method (1.3 +/- 0.7 vs. 2.6 +/- 1.6 days, p = 0.005). CONCLUSIONS Our results support the routine use of the broth culture technique using BacT/Alert blood culture bottles in order to facilitate early streamlining of empiric antibiotic therapy. Gram staining of sediments after centrifugation is associated with low diagnostic yield. Whether the lysis-centrifugation technique could provide additional value in case of peritonitis with a high likelihood of culture-negative results needs to be evaluated.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China.
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Chow KM, Szeto CC, Chow VCY, Wong TYH, Li PKT. Rhodococcus equi peritonitis in continuous ambulatory peritoneal dialysis. J Nephrol 2003; 16:736-9. [PMID: 14733423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The human Rhodococcus equi (R. equi) infection is now emerging, although extrapulmonary manifestation and isolation from patients without human immunodeficiency virus (HIV) infection remains unusual. Considerable effort is required to correctly identify and diagnose this facultative pathogen in patients with peritonitis in end-stage renal failure (ESRF) on continuous ambulatory peritoneal dialysis (CAPD). In the six cases of R. equi CAPD peritonitis reported in this series, diagnoses were made, on average, after 15 days and prolonged antibiotic therapy with morbidity in two patients. A diagnosis of R. equi should be considered in patients with suspected diphtheroid or Nocardia CAPD peritonitis, even with no history of animal contact. This study is the largest series on R. equi CAPD peritonitis and highlights the impact of this disease.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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Abstract
BACKGROUND With the introduction of effective antituberculous chemotherapy, the clinical outcome of tuberculous peritonitis depends much on the diagnostic accuracy of this disease entity. This review summarizes the current state-of-the-art thinking regarding the protean manifestation and diagnostic modalities of this major infectious disease. DATA SOURCES This review was compiled after an extensive search of the current and historical literature, comprising 1,070 cases of tuberculous peritonitis. A number of important areas were highlighted, with emphasis on the diagnostic value and clinical impact of peritoneal biopsy. CONCLUSIONS We believe an aggressive diagnostic approach, particularly with peritoneal biopsy, is warranted for the diagnosis and timely treatment of tuberculous peritonitis.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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