Leukocyte Esterase Reagent Strips for Early Detection of Peritonitis in Patients on Peritoneal Dialysis

Farmer, Christopher; Hobbs, Helen; Mann, Samantha; Newall, Ronald G.; Ndawula, E.; Mihr, Geoffrey; Wilcox, Allan J.; Stevens, Paul E.

doi:10.1177/089686080002000214

Cited by 22 publications

(12 citation statements)

References 7 publications

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“…The reagent strips were used successfully in patients on peritoneal dialysis in the diagnosis of peritonitis. [9][10][11] To our knowledge, only 2 small studies (both reported in abstract form) have evaluated the usefulness of the reagent strip for diagnosis of SBP in cirrhotic patients. In one study, 12 90 ascitic fluid samples were included in the study: Nine samples had more than 250 PMN/mL.…”

Section: Discussionmentioning

confidence: 99%

Rapid Diagnosis of Spontaneous Bacterial Peritonitis by Use of Reagent Strips

Castellote¹

2003

Hepatology

135

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We studied the use of reagent strips for diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. A reagent strip for leukocyte esterase designed for the testing of urine with a colorimetric 5-grade scale (0 to 4) was used to evaluate ascitic fluid in 228 nonselected paracentesis performed in 128 cirrhotic patients. We diagnosed 52 SBP and 5 secondary bacterial peritonitis by means of polymorphonuclear cell count and classical criteria. When we considered positive a reagent strip result of 3 or 4, sensitivity was 89% (51 of 57), specificity was 99% (170 of 171), and positive predictive value was 98%. When we considered positive a reagent strip result of 2 or more, sensitivity was 96% (55 of 57), specificity was 89% (152 of 171), and negative predictive value was 99%. In conclusion, the use of reagent strips is a rapid, easy to use, and inexpensive tool for diagnosis of ascitic fluid infection. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP. (HEPATOLOGY 2003;37: 893-896.)See Editorial on Page 745 S pontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. The prevalence of SBP in unselected patients admitted to the hospital ranges between 10% and 30%. 1 Although infection resolution is high with antibiotic therapy, in-hospital mortality is still over 20%, 2 mainly secondary to hepato-renal syndrome.Sensitive methods of ascitic fluid cultures reach 80% positivity in patients with SBP in the context of clinical trials, 3,4 but, in clinical practice, ascites culture is negative in more than 60% of patients with SBP, 5 and culture results are delayed for several days; thus, diagnosis of SBP must be based on the polymorphonuclear (PMN) cell count. In ascitic fluid, a count of more of 250/mm 3 is highly indicative of SBP and is an indication for antibiotic therapy. However, the ascitic fluid total leukocyte and PMN count is not always available everywhere or cannot be done in an emergency basis.Use of reagent strip testing for leukocyte esterase has been proposed for the rapid diagnosis of meningitis, 6 empyema, 7 urinary tract infections, 8 and peritonitis in patients on peritoneal dialysis. 9 The leukocyte esterase present in the biologic fluid reacts with a chemical compound of the reagent strip causing a color change in the azo dye (purple). The aim of this prospective study is to assess the utility of reagent strips for the rapid diagnosis of SBP in cirrhotic patients with ascites. Patients and MethodsPatients. In a university-based hospital, for an 18-month period, we studied a group of nonselected paracentesis performed on a cohort of cirrhotic patients, at admission, when an SBP was suspected or was clinically indicated. To avoid equivocal results, paracentesis performed at 48 hours after diagnosis of SBP to control infection outcome was not included in the study. Diagnosis of cirrhosis was established by histologic criteria or...

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Section: Discussionmentioning

confidence: 99%

Rapid Diagnosis of Spontaneous Bacterial Peritonitis by Use of Reagent Strips

Castellote¹

2003

Hepatology

135

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“…This test utilizes phenyl pyrrole as the substrate which is hydrolyzed to an intermediate product that reacts with a diazonium salt producing a purple color. Preliminary results from a European study showed a sensitivity of 100% and a specificity of 96%, along with the ability to detect as few as 50 leukocytes/mm 3 (9). In our hands, the PeriScreen Test Strip could detect as few as 100 leukocytes/mm 3 (with a neutrophil count of not less than 50%).…”

Section: Discussionmentioning

confidence: 47%

“…Some of these instances were thought to be due to chylous ascites. In the same study, 12 out of 73 cases (16%) had apparently clear peritoneal effluents despite the presence of peritonitis (9). In the past, the Cytur‐test (Boehringer‐Mannheim, Mannheim, Germany) has been used to diagnose peritonitis based on a dipstick reading (thus avoiding the service of a laboratory).…”

Section: Discussionmentioning

confidence: 93%

“…In addition cloudiness is very subjective and even though most people would agree whether a sample is cloudy or not, there are samples where the cloudiness is hard to interpret. In 1 study, 8 out of 127 (6%) peritoneal dialysate samples were cloudy without any evidence for peritonitis (9). Some of these instances were thought to be due to chylous ascites.…”

Section: Discussionmentioning

confidence: 95%

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Utility of a Peritoneal Dialysis Leukocyte Test Strip in the Diagnosis of Peritonitis

et al. 2002

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Expeditious diagnosis of peritonitis remains a significant goal in the management of patients maintained on peritoneal dialysis. Several attempts to use leukocyte esterase reagent strips to diagnose peritonitis have been described. In this study we examined the usefulness of a new reagent strip, the PeriScreen Test Strip, in the diagnosis of peritonitis. A series of 72 peritoneal effluent samples obtained from 22 maintenance peritoneal dialysis patients is reported. In this study, the test strips had a sensitivity of 100% and a specificity of 98.3% as compared to an abnormal leukocyte count. Thus, in the diagnosis of peritonitis we believe that the PeriScreen Test Strip can be used as a simple bedside screening test to exclude peritonitis in peritoneal dialysis patients.

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“…Leukocyte esterase evaluates the PMN activity in body fluids and its value has been verified in early diagnosis of urinary infection, meningitis, empyema and chorioamnionitis, among others. 19,[23][24][25][26][27][28][29][30] Its use in the evaluation of SBP is fairly recent. It is a low-cost, simple, widely accessible bedside administrable technique which provides results within two minutes, positively influencing the treatment and the prognosis of the disease.…”

Section: Discussionmentioning

confidence: 99%

Is there yet any place for reagent strips in diagnosing spontaneous bacterial peritonitis in cirrhotic patients? An accuracy and cost‐effectiveness study in Brazil

Araújo

Lopes

Michalczuk

et al. 2008

J of Gastro and Hepatol

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Reagent strips are a useful tool for diagnosing SBP in cirrhotic patients, but they have some limitations. Strips are especially indicated when total and differential cell counts are not quickly available or sometimes unavailable. They are also indicated as screening test in emergency rooms to anticipate the diagnosis of SBP and allow its early treatment. It's an interesting option in developing countries.

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Leukocyte Esterase Reagent Strips for Early Detection of Peritonitis in Patients on Peritoneal Dialysis

Cited by 22 publications

References 7 publications

Rapid Diagnosis of Spontaneous Bacterial Peritonitis by Use of Reagent Strips

Rapid Diagnosis of Spontaneous Bacterial Peritonitis by Use of Reagent Strips

Utility of a Peritoneal Dialysis Leukocyte Test Strip in the Diagnosis of Peritonitis

Is there yet any place for reagent strips in diagnosing spontaneous bacterial peritonitis in cirrhotic patients? An accuracy and cost‐effectiveness study in Brazil

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