Analysis of the bacterial flora of infected shunts in dialysis patients and its relation to their oral flora

Objectives: Chronic kidney disease (CKD) is one of non-communicable diseases characteried by the gradual decline in renal function that can leave not only the deterioration of health but also economic burden for patients and their families. Almost advance to end stage of CKD patients have hemodialysis shunt as a treatment method to replace the lost kidney function. The pathology of infectious complications of that hemodialysis access is unknown clearly. Many epidemiological studies showed that oral health status has an intimated relationship with infected shunt sites, but we still lack bacterial evidence. The aims of this study were to identify of bacterial flora in shunt infection using Next Generation Sequencing of the bacterial 16S rRNA gene, then clarify the relationship between oral flora and bacterial flora of infected shunt.
Methods: The infected shunts, pus from infection sites, saliva and dental plaque were collected from four dialysis patients and genomic DNA of bacteria was extracted from each sample. DNA libraries were prepared according to the manufacturer’s recommended protocol and 16S Ribosomal RNA (16S rRNA) gene sequencing analysis was performed using MiSeq (Illumina). Normal PCR was performed to identify the bacterial species using species-specific PCR primer.
Results: From the results of 16S rRNA analysis, the ratio of staphylococcus in saliva of 2 out of 4 patients was abnormally high and oral flora of saliva was similar to that of infected shunt in these two patients. And normal PCR analysis showed that the oral disease-related bacteria including Tannerella Forsythensis existed in the infected unused shunt.
Conclusions: Since oral cavity specific bacteria were observed in the unused shunt, it is suggested that oral bacteria may be one of the causes of shunt infection in the dialysis patients.