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Leukocyte Esterase Reagent Strips Test for Spontaneous Bacterial Peritonitis: Presented at AASLD

By Jane Salodof MacNeil

BOSTON, MA -- October 31, 2003 -- Leukocyte esterase reagent strips diagnosed spontaneous bacterial peritonitis (SBP) with 96% to 100% accuracy when tested in a French-American study.

Investigators at the Centre Hospitalier General in Chateauroux, France, and the University of Southern California (USC) in Los Angeles, United States, wanted to see whether the strips, widely used for rapid urine analysis, could expedite bedside diagnosis of SBP, an often-fatal complication of cirrhosis. They tested two brands -- Nephur-Test and Multistix -- in a total of 176 ascites fluid samples from 76 patients with liver disease.

"Early identification and treatment are the keys to survival," said investigator Michel H. Mendler, MD, of the Keck School of Medicine at USC. Presenting the study at the 54^th Annual Meeting of the American Association for the Study of Liver Diseases, he reported that SBP has a mortality rate of 20% to 50%.

The study was conducted in inpatient and ambulatory settings. In both countries, samples were also sent out for traditional laboratory testing, a process that can range from hours to a day, according to Mendler. In contrast, the Nephur-Test took 60 seconds to read and the Multistix 120 seconds.

The goal was not to replace laboratory tests, but to develop a rapid screening tool to help physicians decide whether to institute treatment. Even if the strips came into regular use, Mendler said it would still be necessary to confirm the results.

He proposed that a probable treatment algorithm would be to start treatment immediately if a strip gives a positive result. If negative, he suggested, treatment could wait for confirmation unless there was strong clinical suspicion of infection.

"The screening of SBP with leukocyte esterase reagent strips is promising," Mendler said. "The results will vary according to the brand of strip and prevalence of SBP."

It is also very inexpensive, he added: "Theoretically, it should not cost more than [the] cost of [the] strip, which is very cheap -- 50 cents in America, 15 in France."


[Study title: Rapid Diagnosis of Spontaneous Bacterial Peritonitis with Leukocyte Esterase Reagent Strips (Nephur-Test) and Multistix in Two Centers. Abstract 69]

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