Editorial
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World J Gastroenterol. Mar 7, 2011; 17(9): 1091-1094
Published online Mar 7, 2011. doi: 10.3748/wjg.v17.i9.1091
Diagnosis of spontaneous bacterial peritonitis: An update on leucocyte esterase reagent strips
Anastasios Koulaouzidis
Anastasios Koulaouzidis, Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH164SA, United Kingdom
Author contributions: Koulaouzidis A solely contributed to this paper.
Correspondence to: Dr. Anastasios Koulaouzidis, MD, MRCP, MACG, FEBG, Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH164SA, United Kingdom. akoulaouzidis@hotmail.com
Telephone: + 44-131-2421126 Fax: +44-131-2421618
Received: November 10, 2010
Revised: January 18, 2011
Accepted: January 25, 2011
Published online: March 7, 2011
Abstract

Ascites remain the commonest complication of decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid (AF) in the absence of a contiguous source of infection and/or an intra-abdominal inflammatory focus. An AF polymorphonuclear (PMN) leucocyte count ≥ 250/mm3 -irrespective of the AF culture result- is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. However, this is a crucial step in SBP management. Since 2000, 26 studies (most of them published as full papers) have checked the validity of using leukocyte esterase reagent strips (LERS) in SBP diagnosis. LERS appear to have low sensitivity for SBP, some LERS types more than others. On the other hand, though, LERS have consistently given a high negative predictive value (> 95% in the majority of the studies) and this supports the use of LERS as a preliminary screening tool for SBP diagnosis. Finally, an AF-tailored dipstick has been developed. Within the proper setting, it is set to become the mainstream process for handling AF samples.

Keywords: Peritonitis; Leukocytes; Esterases; Diagnosis; Reagent strips; Bacterial