Application of targeted next-generation sequencing in the etiological diagnosis of peritoneal dialysis-associated peritonitis

Background Accurate and rapid pathogen identification is crucial for the effective treatment of peritoneal dialysis-associated peritonitis (PDAP). Targeted next-generation sequencing (tNGS) has gained popularity for detecting infectious diseases due to its defined pathogen targeting and enhanced detection efficiency. However, its application in elucidating the pathogen identication of PDAP remains unexplored. Methods We prospectively enrolled patients with PDAP from November 2023 to January 2025. Both tNGS and traditional microbial culture (TMC) were performed simultaneously. Results Our cohort included 35 patients with PDAP. tNGS achieved a significantly higher pathogen detection rate (PDR) than TMC (82.9% vs. 48.6%, P = 0.008). tNGS detected polymicrobial infections in 10 samples, whereas TMC identified none. Beyond common pathogens, tNGS also detected rare ones, including human herpesvirus and the Mycobacterium tuberculosis complex. tNGS also demonstrated a significantly shorter detection time than TMC (22.63 h vs. 66.37 h, P < 0.001). Among the patients with prior antibiotic exposure (54.3%), tNGS maintained a higher PDR than that of TMC (89.5% vs. 26.3%, P < 0.001). Moreover, peritoneal dialysis catheter removal rates were lower in the treatment adjustment group guided by tNGS than in the TMC group (8.7% vs. 50.0%, P = 0.046). Conclusions tNGS showed a significantly higher PDR and a shorter detection time than that of TMC in patients with PDAP, particularly among those with prior antibiotic exposure. This method also identified rare pathogens often missed by traditional diagnostic methods. These findings highlight the potential of tNGS for widespread use in the etiological diagnosis of PDAP.