How is spontaneous bacterial peritonitis (SBP) diagnosed rapidly?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

A development in the rapid diagnosis of spontaneous bacterial peritonitis (SBP) has been the proposed use of bedside reagent strips read by a portable spectrophotometric device. In a pilot study, this combination achieved a 100% sensitivity in diagnosis of SBP. [19]  In a separate, small cohort, the average time saved from dipstick to laboratory results ranged from 2.73 hours (dipstick to validated result from automated counter) to 3 hours (dipstick to validated manual cell count of ascitic fluid). [20]  

More recently, a study that evaluated the sensitivity of a bedside leukocyte esterase reagent strip for the detection of SBP in 330 emergency department ascites patients undergoing paracentesis (635 fluid analyses) found a 95% sensitivity, 48% specificity, 11% positive predictive value, and 99% negative predictive value at 3 minutes at the trace threshold of SBP prediction. [21]  Given these results, the reagent strip is not recommended as a standalone test.

This diagnostic method holds promise in replacing the time-consuming process of manual cell counting, which is often unavailable in many laboratories "after hours." The decreased time to diagnosis may result in a significant reduction of the time from paracentesis to antibiotic treatment of presumptive SBP.


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