Serum bacterial DNA detection in patients with cholangitis after Kasai procedure.

Background: The aim of this study was to investigate the detectability of bacterial DNA (bactDNA) and associated clinical factors in patients with cholangitis after the Kasai procedure through the identification of bactDNA in blood.

Methods: A cross-sectional study of 110 patients who had undergone the Kasai procedure was carried out. A total of 77 patients had cholangitis and 33 did not. Blood samples were obtained on admission or on follow up at the outpatient visit. bactDNA was analyzed using a polymerase chain reaction-based method, DNA nucleotide sequencing, for identification of bacterial species.

Results: Rate of bactDNA positivity was higher using the 16SrDNA method than the culture method (58.4% vs 14.3%, P < 0.0001), and more patients with cholangitis were positive for bactDNA compared with the patients without cholangitis (58.4% vs 39.4%, P = 0.095). Bacteria identified on blood 16SrDNA primarily consisted of opportunistic pathogens derived from the gut, including Escherichia coli, Klebsiella pneumoniae, Shigella fexneri, and Enterobacteriaceae bacterium. Treatment with probiotics or antibiotics showed a trend toward reduced prevalence of bactDNA. Pediatric end-stage liver disease score, procalcitonin, C-reactive protein, and heart rate were all significantly associated with the presence of bactDNA.

Conclusion: bactDNA is frequently detected in patients with cholangitis after the Kasai procedure compared with those without cholangitis (and controls), and the bacteria are similar to those in the gut, suggesting that it is useful as an early diagnostic tool for cholangitis and other infections (registration number in Chinese Clinical Trial Registry ChiCTR-ECC-13003759).