Diagnostic usefullness of leukocyte esterase dipstick test for diagnosis of spontaneous bacterial peritonitis in cirrhotic patients in a tertiary care hospital.

Ramesh Kumar, T S (2014) Diagnostic usefullness of leukocyte esterase dipstick test for diagnosis of spontaneous bacterial peritonitis in cirrhotic patients in a tertiary care hospital. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Ascites refers to excessive pathologic accumulation of fluid in Peritoneal cavity27. The most common cause of ascites is CIRRHOSIS WITH PORTAL HYPERTENSION (85%)which occurs in 50% within 10 years of diagnosing cirrhosis. The development of ascites denotes the patient progresses to decompensated cirrhosis.Other complications are variceal hemorrhage, hepatic encephalopathy or jaundice; ascites is the most common. It is due to factors involving the peritoneum (malignancy), infection,or diseases away from the peritoneum , heart failure, hypoproteinaemia,liver disease). Cirrhosis most important causative agent of ascites in the West (76%), peritoneal malignancy (14%), cardiac failure (5%) and peritoneal tuberculosis(4%). Cirrhosis is a linguistic disorder with indolent course and many patients will be asymptomatic until decompensation. Early and wellcompensated cirrhosis usually present as loss of apetite and weight loss, malaise, fatigue and weakness. Decompensated Liver Disease is an end stage liver disorder with liver fibrosis and with complications like ascites, variceal bleeding,hepatic encephalopathy,enzymes production and reduced metabolism,hepatopulmonary syndrome. Hence, this study was done to detect Ascitic Fluid Infections (AFIs) in outpatients & inpatients with Decompensated Liver Disease (DCLD), by bedside inoculation of ascitic fluid in leucocyte esterase ascitic fluid strip test. This could increase diagnosting infection at earlier time, facilitate rapid isolation of organisms and help to administer appropriate antimicrobialtherapy at the earliest. AIMS & OBJECTIVES : 1.The usefulness of leukocyte esterase ascitic fluid strip analysis in the rapid and early diagnosis of spontaneous bacterial peritonitis on decompensated chronic liver disease patients with ascites, so that rapid diagnosis of ascitic fluid infection and starting early treatment to reduce the morbidity and mortality of the disease which can be established. 2.The Objective is to find out the leukocyte esterase ascitic fluid strip analysis accuracy in the spontaneous bacterial peritonitis and after successful treatment with iv antibiotics the efficacy of the strip test in spontaneous bacterial peritonitis. 3.To study the Incidence and Prevalence of Ascitic Fluid Infections (AFIs) in Cirrhotic patients of various etiologies. 4. To Allegorize the prevalence of Ascitic Fluid Infections (AFIs) inoutpatients & inpatients with Cirrhosis. 5. To Establish whether bedside strip tests and bed side inoculation of ascitic fluid into bloodculture bottles combined with newer culture detection methods employing non-ionic surfactants (Triton-X 100 and Tween 80) helps in the identification of ascitic fluid infection. 6. To study the microbial spectrum of Ascitic Fluid Infections (AFIs) from outpatients & inpatients with DCLD. CONCLUSION : In conclusion, our study shows that LER strip test has Excellent accuracy for SBP, and it is having high speed, less cost, easy to use, and doesn’t require expert hands. Because of its speed, the use of this test may help early institution of antibiotic therapy in patients with SBP. The prevalence of AFIs among DCLD patients with cirrhosis was 79% and the prevalence among patients with various other etiologies for DCLD (like Cryptogenic, Budd Chiari Syndrome, Hepatocellular carcinoma etc) was 28%. The prevalence of AFIs was 26% among outpatients and 44.7% among inpatients with DCLD. Klebsiella was the most common isolate (30.4%), followed by Escherichia coli (12.6%) and Staphylococcus aureus (12.8%). Gram positive cocci (77%) were the predominant cause of AFIs among outpatients and Gram negative bacilli (75.9%) were predominant cause of AFIs among inpatients. The prevalence of Methicillin Resistant Staphylococcus (MRS) and Extended Spectrum Beta Lactamase producers (ESBL) were 12.5% and 20% among outpatients & 66.5% and 40.4% among inpatients respectively.25% of Enterococci isolated among inpatients exhibited Vancomycin Resistance (VRE) and High Level Aminoglycoside Resistance (HLAR).The prevalence of carbapenemase production was 2.1% among isolates from inpatients. The percentage of resistance to norfloxacin among GNB and GPC isolated from outpatients was 0% and 50% & inpatients was 61.7% and 67% respectively. The percentage of resistance to ciprofloxacin among GNB and GPC isolated from outpatients was 20% and 25% & inpatients was 29.8% and 22.2% respectively.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diagnostic usefullness ; leukocyte esterase dipstick test ; ; spontaneous bacterial peritonitis ; cirrhotic patients ; tertiary care hospital.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:20
Last Modified: 13 Jul 2017 04:20
URI: http://repository-tnmgrmu.ac.in/id/eprint/1588

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