Background: Ethyl glucuronide (EtG) is a minor ethanol metabolite used as a specific marker to document recent alcohol consumption; confirm abstinence in treatment programs, workplaces, and schools; and provide legal proof of drinking. This study examined if bacterial pathogens in urine may enable postsampling synthesis of EtG and ethyl sulfate (EtS) from ethanol, leading to clinical false-positive results. Methods: Urine specimens with confirmed growth of Escherichia coli, Klebsiella pneumoniae, or Enterobacter cloacae were stored at room temperature in the presence of ethanol. Ethanol was either added to the samples or generated by inoculation with the fermenting yeast species Candida albicans and glucose as substrate. EtG and EtS were measured by LC-MS. Results: High concentrations of EtG (24-h range 0.5-17.6 mg/L) were produced during storage in 35% of E. coliinfected urines containing ethanol. In some specimens that were initially EtG positive because of recent alcohol consumption, EtG was also sensitive to degradation by bacterial hydrolysis. In contrast, EtS was completely stable under these conditions. Conclusions: The presence of EtG in urine is not a unique indicator of recent drinking, but might originate from postcollection synthesis if specimens are infected with E. coli and contain ethanol. Given the associated risks for false identification of alcohol consumption and false-negative EtG results due to bacterial degradation, we recommend that measurement of EtG be combined with EtS, or in the future possibly replaced by EtS.
© 2007 American Association for Clinical ChemistryEarly recognition of problem drinking or relapse is important to ensure adequate alcohol treatment strategies (1 ). This goal has been hampered by a lack of sufficiently sensitive and specific diagnostic methods. The reliability of self-reporting is limited by denial and underreporting (2 ). The time frame for identifying alcohol use by ethanol testing is usually limited to Ͻ12 h, because of rapid metabolism and excretion (3 ). Research has therefore focused on developing alcohol biomarkers with a longer detection window (4 ).A new laboratory marker for detecting recent alcohol consumption is ethyl glucuronide (EtG) (5 ). EtG and ethyl sulfate (EtS) (6 ) are minor ethanol metabolites formed by uridine diphosphate-glucuronosyltransferase (UGT) and sulfotransferase (SULT), respectively, and excreted in urine for a longer time than ethanol (7-10 ). Positive EtG and/or EtS test results thus provide a strong indication that the person has recently consumed alcohol, even when ethanol is no longer detectable (9 ). LC-MS methods are available for EtG and EtS detection (6, 10 ), as is an enzyme immunoassay for EtG (DRI ® EtG, Microgenics). EtG has been recommended for forensic application (11-13 ) and is used for documentation of abstinence in treatment programs, for alcohol testing in the workplace and schools, and as legal proof of drinking (known as "the 80-h alcohol test"). However, the high diagnostic sensitivity of the EtG test has ...