Evaluation of leucocyte esterase reagent strip test for the rapid bedside diagnosis of spontaneous bacterial peritonitis

Abstract

LER strip testing of ascitic fluid is a rapid, cheap and sensitive bed side tool for the diagnosis of SBP.

Multistix 10 SG Leukocyte Esterage Dipstick Testing in Rapid Bedside Diagnosis of Spontaneous Bacterial Peritonitis: A Prospective Study

“…However, when using a cut-off of grade 3, the sensitivity, specificity, PPV and NPV were 92%, 100%, 100% and 98% respectively. 24 Our study showed less sensitivity but high specificity and NPV ( Table 2). The result of our study was nearly similar to studies published by Butani et al and Ribeiro et al 14,20 Our study expands previous findings of the potential utility of the LERS test as a simple, rapid and inexpensive means for testing in settings involving SBP.…”

“…Compared with the manual PMN count ('gold standard'), LERS were found to have sensitivity ranging from 45 to 100%, specificity ranging from 81 to 100%, PPV value ranging from 42 to 100% and NPV ranging from 87 to 100%. [4][5][6][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Similarly, the published studies in which Multistix reagent strips were used have also shown widely variable test results (Table 3). 4,[12][13][14][17][18][19][20]24 In an only study from India, authors have shown the Multistix strip's sensitivity, specificity, PPV and NPV of 97%, 89%, 87% and 83% respectively using a cut-off of grade 2.…”

Routine analysis of cirrhotic ascites for evidence of infection – not worth the effort?

“…Another option is to use leukocyte esterase reagent (LER) strips for the bedside diagnosis of SBP [13]. LER technique has been shown to be cheaper, faster (it takes less than a minute) and well reproducible [14]. If LER test is positive, the fluid should be immediately inoculated into culture medium and another sample sent for cell count.…”

Fluorescence in-situ hybridization as a novel technique for rapid and sensitive detection of ascitic fluid infection

“…On the basis of the results obtained from absolute white cell count and culture of the ascitic fluid (AF), five variants of peritoneal fluid infection have been recognized [3]. These are (i) SBP: absolute count of polymorphonuclear leukocytes (PMNs) in AF of at least 250/mm 3 and a positive culture showing a single type of bacteria; (ii) culture-negative neutrocytic ascites (CNNA): negative AF culture with a PMN count greater than 250/mm 3 ; (iii) monomicrobial non-neutrocytic bacterascites: culturepositive AF for one type of bacteria and a PMN count lesser than 250/mm 3 ; (iv) secondary bacterial peritonitis: characterized by polymicrobial growth from AF with a PMN count of at least 250/mm 3 and a surgically treatable source of infection; and (v) polymicrobial bacterascites: PMN count less than 250/mm 3 [4]. SBP represents AF in the absence of a contiguous source of infection and/or spontaneous infection with an intraabdominal (and a potentially surgically treatable) inflammatory focus [5].…”