title: Detection of molecular bacterascites in decompensated cirrhosis defines a risk with decreased survival.
abstract: BACKGROUND
  The prognostic relevance of bacterial DNA (bactDNA) detection in ascitic fluid of patients with cirrhosis is still under debate. Using quantitative real-time PCR with broad-range primers targeting the V3 and V4 variable region of the 16S rRNA gene, we measured bactDNA concentrations in patients with and without leukocytic ascites and evaluated the impact on short-term survival.
  
  
  METHODS
  Ascites samples from 173 patients with decompensated cirrhosis were consecutively collected between February 2011 and December 2012. BactDNA-positive ascites samples were sequenced and chromatograms were identified using RipSeq. Clinical data collection and survival analyses were carried out retrospectively and correlated with ascites bactDNA levels.
  
  
  RESULTS
  BactDNA was detected qualitatively with a similar frequency in both nonleukocytic and leukocytic ascites [40% (57/144) and 43.5% (10/23), respectively; P=0.724]. However, the median bactDNA level was significantly higher in leukocytic ascites than in nonleukocytic ascites (1.2×10 vs. 5.7×10 copies/ml; P=0.008). Patients' survival was associated significantly with bactDNA level. The 30-day and 180-day survival was reduced if bactDNA was above the quantification limit of 520 copies/ml (84 and 63% vs. 72 and 43%, respectively; P<0.05) and worst if bactDNA was above 5000 copies/ml. The bacterial spectrum was dominated by Gram-positive strains as shown by direct sequencing.
  
  
  CONCLUSIONS
  BactDNA quantification in ascitic fluid samples using culture-independent 16S rRNA gene-based methods seems to be an interesting approach to identify patients at risk of reduced survival. Our study warrants further evaluation of antibiotic treatment in patients with molecular bacterascites.
authors: aDepartment of Internal Medicine, Neurology, Dermatology, Section of Hepatology, University Hospital Leipzig, Leipzig bDepartment of Gastroenterology and Hepatology, Hospital and Outpatient Clinic for Internal Medicine A, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors: Cornelius
authors: C
authors: Engelmann
authors: Sandra
authors: S
authors: Krohn
authors: Delia
authors: D
authors: Prywerek
authors: Jan
authors: J
authors: Hartmann
authors: Adam
authors: A
authors: Herber
authors: Albrecht
authors: A
authors: Boehlig
authors: Katharina
authors: K
authors: Zeller
authors: Stephan
authors: S
authors: Boehm
authors: Thomas
authors: T
authors: Berg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001201:Ascites / Q000150:complications / Q000382:microbiology*; D001202:Ascitic Fluid / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial