Rapid diagnosis of spontaneous bacterial peritonitis with leukocyte esterase reagent strips in a European and in an American center

• Published in: Journal of gastroenterology and hepatology Vol. 20; no. 2; pp. 187 - 192
• Main Authors: SAPEY, THIERRY, MENA, EDWARD, FORT, ERIC, LAURIN, CHRISTINE, KABISSA, DENIS, RUNYON, BRUCE A, MENDLER, MICHEL-HENRY
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Science Pty 01-02-2005; Blackwell Science
• Subjects: Abdomen; ascites; Ascites - complications; Ascites - microbiology; Ascitic Fluid - cytology; Ascitic Fluid - microbiology; Bacterial Infections - diagnosis; Bacteriological Techniques - methods; Biological and medical sciences; Carboxylic Ester Hydrolases; cirrhosis; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Leukocyte Count; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Paracentesis; Peritonitis - diagnosis; Peritonitis - microbiology; portal hypertension; Prospective Studies; Reagent Strips; Regression Analysis; Sensitivity and Specificity; spontaneous bacterial peritonitis; Time Factors; Europe; Portal circulation disease; Effusion; American; Enzyme; Leukocyte; Spontaneous; Cardiovascular disease; Hepatic disease; Esterases; European; Infection; Vascular disease; Cirrhosis; Abdominal disease; Reagent strip; Portal hypertension; Bacteriosis; Digestive diseases; Hydrolases; Diagnosis; spontaneous bacterial peritonitis; Ascites; Peritonitis
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2004.03554.x

Background:  Timely diagnosis and treatment of spontaneous bacterial peritonitis (SBP) are essential to survival. The purpose of the present paper was to evaluate leukocyte esterase reagent strips (Nephur‐Test and MultistixSG10) in the bedside diagnosis of SBP.
Methods:  Patients with cirrhotic ascites were prospectively included in France (center 1) and in the USA (center 2). Paracenteses were performed on admission and repeated as indicated. Bedside reagent strip testing was performed on the ascitic fluid and compared to manual cell count with differential and ascitic fluid culture. In center 1, the Nephur‐Test was tested in all cases, with dual testing with MultistixSG10 in a subgroup. In center 2, all cases had dual testing. Spontaneous bacterial peritonitis was defined as a polymorphonuclear ascites count ≥250/µL.
Results:  A total of 184 samples was obtained in 76 patients. Center 1 included 151 samples from 53 patients. Seven samples had SBP, obtained in six patients. Center 2 included 33 samples from 23 patients. Six samples had SBP, obtained in five patients. The sensitivity, specificity, positive and negative predictive value of the reagent strips were as follows. Center 1/Nephur‐Test: 86%, 100%, 100%, 99%; center 1/MultistixSG10: 100%, 100%, 100%, 100%; center 2/Nephur‐Test: 100%, 92.5%, 75%, 100%; center 2/MultistixSG10: 83%, 96%, 83%, 96%.
Conclusion:  Leukocyte esterase reagent strips may provide a rapid bedside diagnosis of SBP.