Abstract / Summary
Abstract Background Culture-negative, refractory and relapsing peritoneal dialysis–associated peritonitis (PDAP) is challenging partly due to limited detection of atypical pathogens by traditional culture. Hybrid capture–based targeted next-generation sequencing (hc-tNGS) can improve pathogen identification in the complicated PDAP, including viral detection. Methods A retrospective case series was undertaken to evaluate the clinical significance of hc-tNGS in identifying pathogens in dialysis effluent of patients with culture‑negative, refractory, or recurrent PDAP. Dialysis effluent specimens were tested by both traditional culture and hc-tNGS, and pathogen detection rates were compared. Results From October 2024 to December 2025, 14 patients were enrolled. The pathogen detection rate of hc-tNGS was higher than that of culture (79% vs 43%). In 6 of 8 culture‑negative cases, hc-tNGS identified pathogens. Viral sequences were detected in 7 patients (50%); 6 had clinically relevant viral peritonitis. Virus‑positive patients showed significantly lower serum C‑reactive protein (P = 0.05), peripheral white blood cell count (P = 0.02), and effluent lactate dehydrogenase (P = 0.02) than virus‑negative patients. After treatment was adjusted based on hc‑tNGS findings, including antiviral therapy, all 6 patients with clinically relevant viral peritonitis achieved clinical remission. Overall, 9 patients (64%) attained clinical remission, and 5 (35.7%) experienced technical failure. Conclusion Hc-tNGS technology has improved the ability to detect pathogens in complicated PDAP, particularly revealing that viral infection is a common yet often overlooked cause of culture-negative, refractory, and recurrent PDAP. Identifying this “low-inflammation” viral phenotype provides a preliminary basis for targeted antiviral treatment, which may further optimize clinical management strategies for high-risk PDAP patients. Trial Registration (where applicable) : Not applicable.