Recent studies have shown that the diagnosis of spontaneous bacterial peritonitis can be rapidly obtained using leukocyte esterase reagent strips.
However, published studies were restricted to 1 or 2 centers, and the number of patients with spontaneous bacterial peritonitis was thus limited.
Dr Jean Babtiste Nusbaum and colleagues from France conducted a multicenter study to assess the diagnostic accuracy of the Multistix 8SG urine test for the diagnosis of spontaneous bacterial peritonitis.
The investigative team also assessed the prevalence of spontaneous bacterial peritonitis.
The investigators tested 2 reactive strips independently in patients with cirrhosis and in outpatients undergoing paracentesis.
|Prevalence of bacterial peritonitis was 1% in outpatients|
Cultures of ascitic fluid were performed at the bedside using aerobic and anaerobic blood culture bottles.
The investigators performed 2123 paracenteses in 1041 patients from 70 centers.
The team noted that 117 samples obtained from 91 patients, had ascites polymorphonuclear cell counts 250 per liter.
Among these, 56 were associated with positive ascitic fluid cultures.
The prevalence of spontaneous bacterial peritonitis was 6% in the whole population, 9% in inpatients, and 1% in outpatients.
The investigators observed that the prevalence of spontaneous bacterial peritonitis was 1% in asymptomatic outpatients.
The prevalence of spontaneous bacterial peritonitis was 2% in symptomatic outpatients.
Using a threshold of 2+ for positivity of the reagent strip, sensitivity was 45% for the diagnosis of spontaneous bacterial peritonitis.
The team noted that the specificity was 99%.
The team found that the positive predictive value was 78%, with a negative predictive value of 97%.
Dr Nusbaum's team concluded, "This study confirms the low prevalence of spontaneous bacterial peritonitis in asymptomatic outpatients according to a priori defined criteria."
"The study also indicates an absence of diagnostic efficacy for this specific strip test."