Rapid diagnosis of spontaneous bacterial peritonitis with leukocyte esterase reagent strips in a European and in an American center.
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 > or =250/microL.


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%.


CONCLUSIONS
Leukocyte esterase reagent strips may provide a rapid bedside diagnosis of SBP.
Sapey
Thierry
T
Service Hepatogastroenterologie, Center Hospitalier General de Chateauroux, 216 Avenue de Verdun, 36000 Chateauroux, France. thierrysapey@hotmail.com
Mena
Edward
E
Fort
Eric
E
Laurin
Christine
C
Kabissa
Denis
D
Runyon
Bruce A
BA
Mendler
Michel-Henry
MH
D001201:Ascites / Q000150:complications / Q000382:microbiology; D001202:Ascitic Fluid / Q000166:cytology / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis*; D001431:Bacteriological Techniques / Q000379:methods; D002265:Carboxylic Ester Hydrolases; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D011934:Reagent Strips; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013997:Time Factors
D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases