Use of reagent strips for the rapid diagnosis of spontaneous bacterial empyema.
OBJECTIVE
To assess the utility of reagent strips for rapid diagnosis of spontaneous bacterial empyema in cirrhotic patients with hepatic hydrothorax.


BACKGROUND
Analysis of ascitic fluid using reagent strips is a useful diagnostic test for spontaneous bacterial peritonitis.


METHODS
A reagent strip for leukocyte esterase designed for the testing of urine was used to evaluate pleural fluid analysis in 47 nonselected thoracenteses in 28 cirrhotic patients with hepatic hydrothorax.


RESULTS
Twelve spontaneous bacterial empyemas were diagnosed. Simultaneous spontaneous bacterial peritonitis was present in 7 of 10 cases in which ascites fluid was analyzed. When a test result of 3 or 4 was considered positive, sensitivity was 83% (10 of 12), specificity was 100% (35 of 35), and positive predictive value was 100%. When result of 2 or more was considered positive, sensitivity was 92% (11 of 12), specificity was 80% (28 of 35), and negative predictive value was 97%.


CONCLUSIONS
Analysis of pleural fluid with reagent strips is a rapid, easy to use, and inexpensive tool for the diagnosis of spontaneous bacterial empyema in cirrhotic patients. A positive result should be considered an indication for antibiotic therapy.
Castellote
Jose
J
Servicio de Aparato Digestivo, IDIBELL Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. jcastellote@csub.scs.es
Lopez
Carmen
C
Gornals
Juan
J
Domingo
Alicia
A
Xiol
Xavier
X
D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D001431:Bacteriological Techniques / Q000295:instrumentation*; D002265:Carboxylic Ester Hydrolases / Q000032:analysis; D003124:Colorimetry / Q000379:methods; D003937:Diagnosis, Differential; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000382:microbiology; D005122:Exudates and Transudates / Q000737:chemistry / Q000166:cytology / Q000382:microbiology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology; D011237:Predictive Value of Tests; D011934:Reagent Strips; D012680:Sensitivity and Specificity; D013997:Time Factors
D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases