Gram's Stain of Peritoneal Fluid Is Rarely Helpful in the Evaluation of the Ascites Patient - 14/09/13
, Casey Fox, BS, Gregory W. Hendey, MD
Address for correspondence: Brian Chinnock, MD, UCSF-Fresno Building, 155 Fresno Street, Suite 216, Fresno, CA 93701; 559-499-6440, fax 559-499-6441Résumé |
Study objective |
We determine the sensitivity, specificity, and clinical utility of the Gram's stain of peritoneal fluid in patients undergoing paracentesis.
Methods |
We conducted a retrospective chart review of all peritoneal fluid analyses in a 3-year period in an urban 3-hospital system. Peritoneal dialysis and diagnostic peritoneal lavage patients were excluded. Data collected included Gram's stain, cell count, and culture results. Spontaneous bacterial peritonitis was defined as an absolute neutrophil count greater than 250 cells/mm3. In patients with a positive Gram's stain result, charts were reviewed for antibiotic changes. Primary outcome measures were the sensitivity, specificity, and predictive values of the Gram's stain for the detection of spontaneous bacterial peritonitis.
Results |
Of 796 fluid samples, Gram's stain demonstrated an organism in 31 (3.9%; 95% confidence interval [CI] 2.6% to 5.4%). Gram stain had a sensitivity of 10% (95% CI 6% to 15%), specificity of 97.5% (95% CI 96.7% to 98.3%), positive predictive value of 48% (95% CI 32% to 65%), and negative predictive value of 81.3% (95% CI 80.7% to 82.0%) in the detection of spontaneous bacterial peritonitis. Antibiotic treatment of spontaneous bacterial peritonitis was changed after Gram's stain results in only 1 case, and 16 of 31 positive Gram's stain results occurred in patients without spontaneous bacterial peritonitis, likely representing contaminants.
Conclusion |
The Gram's stain result was rarely positive in patients undergoing paracentesis, and when positive, it rarely provided clinically useful information.
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| Supervising editor: Gregory J. Moran, MD |
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| Author contributions: BC conceived the study. BC, CF, and GWH designed the study. BC and CF supervised and managed the data collection. BC and CF did all final data analysis, and GWH provided statistical advice. BC and GWH drafted the article. BC, CF, and GWH worked on the revision. BC takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. |
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| Reprints not available from the authors. |
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| Publication date: Available online February 7, 2009. |
Vol 54 - N° 1
P. 78-82 - juillet 2009 Retour au numéro
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