Evaluation of Various Non Culture Methods for the Diagnosis of Spontaneous Bacterial Peritonitis

Introduction: Spontaneous Bacterial Peritonitis (SBP) iscommon and serious complication of patients with livercirrhosis and ascites, without an apparent surgically treatableintra abdominal source of infection. Its prevalence rangesfrom 10% to 30%. Mortality rate was earlier reported morethan 90%, but it has now reduced to 30% -50% as a resultof rapid diagnosis and prompt initiation of antibiotics. Thepresent study was done to evaluate the various non culturemethods for the diagnosis of SBP.Material and Methods: Ascitic fluid sample were collectedaseptically from 100 cirrhotic patients with ascites. PMN(polymorphonuclear leukocyte) count was determined byNeubauer’s manual counting chamber and Leishman’s stainfor differential PMN cell counts. Granulocyte esterase activitywas detected using LER (Leukocyte esterase reagent) dipstickstrips.Results: Out of 100 samples processed, PMN cell count >250 cells/mm3 was found in 91% samples by conventionallight microscopy. Scale of > 2+ by LER strip was found in61 samples. Reading of PMN cell count of > 250 cells/mm3matched in 60 samples and < 250 cells/mm3 matched in 8 cellsby both microscopy and LER strip test. Sensitivity, specificity,positive predictive value and negative predictive value ofLER strip test was 65.9%, 88.89%, 98.36% and 20.51%respectively.Conclusion: LER strips as a screening tool for SBP haveadvantage of speed, low cost, availability at odd hours, requiresno technical expertise and can be performed everywhere.Its high specificity and PPV may help in early institution ofempirical antibiotic therapy in patients.