Leukocyte Esterase and Glucose Reagent Test Can Rule in and Rule out Septic Arthritis

Overview

Journal In Vivo

Specialty Oncology

Date 2021 Apr 29

PMID 33910845

Citations 2

Authors

Louisa Kolbeck

Marco Haertle

Tilman Graulich

Max Ettinger

Eduardo M Suero

Christian Krettek

Mohamed Omar

Affiliations

Soon will be listed here.

Abstract

Background/aim: Septic arthritis (SA) requires rapid diagnosis and therapy to avoid joint damage. This study evaluated the diagnostic accuracy of leukocyte esterase (LE) and glucose (GLC) strip tests for diagnosing SA.

Patients And Methods: Synovial fluids from 455 patients with atraumatic joint effusions were assessed prospectively over a 5-year period with LE and glucose strip tests. Results were compared to modified Newman criteria for diagnosing joint infections. Synovial fluid cultures, crystal, blood and synovial cell analyses were also performed.

Results: Forty-one patients had SA and 252 non-SA. A positive LE reading combined with negative glucose reading could detect SA with 100% specificity, 85% sensitivity, 100% positive predictive value (PPV) and 98% negative predictive value (NPV). Positive synovial LE reading alone detected SA with 82% specificity, 95% sensitivity, 47% PPV, and 99% NPV.

Conclusion: Combined LE and glucose strip tests represent a low-cost tool for rapidly diagnosing or ruling out SA.

Citing Articles

Diagnostic Accuracy for Periprosthetic Joint Infection Does Not Improve by a Combined Use of Glucose and Leukocyte Esterase Strip Reading as Diagnostic Parameters.

Haertle M, Kolbeck L, Macke C, Graulich T, Stauss R, Omar M J Clin Med. 2022; 11(11).

PMID: 35683369 PMC: 9181009. DOI: 10.3390/jcm11112979.

[Management of joint empyema].

Brand J, Neubauer T, Omar M Unfallchirurg. 2021; 125(1):19-25.

PMID: 34874470 DOI: 10.1007/s00113-021-01107-2.

References

Faraj A, Omonbude O, Godwin P . Gram staining in the diagnosis of acute septic arthritis. Acta Orthop Belg. 2002; 68(4):388-91. View

Gupta M, Sturrock R, Field M . A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). 2001; 40(1):24-30. DOI: 10.1093/rheumatology/40.1.24. View

Kaandorp C, Krijnen P, Moens H, Habbema J, van Schaardenburg D . The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum. 1997; 40(5):884-92. DOI: 10.1002/art.1780400516. View

Shahi A, Tan T, Kheir M, Tan D, Parvizi J . Diagnosing Periprosthetic Joint Infection: And the Winner Is?. J Arthroplasty. 2017; 32(9S):S232-S235. DOI: 10.1016/j.arth.2017.06.005. View

McGillicuddy D, Shah K, Friedberg R, Nathanson L, Edlow J . How sensitive is the synovial fluid white blood cell count in diagnosing septic arthritis?. Am J Emerg Med. 2007; 25(7):749-52. DOI: 10.1016/j.ajem.2006.12.001. View

Mathews C, Weston V, Jones A, Field M, Coakley G . Bacterial septic arthritis in adults. Lancet. 2010; 375(9717):846-55. DOI: 10.1016/S0140-6736(09)61595-6. View

McCutchan H, Fisher R . Synovial leukocytosis in infectious arthritis. Clin Orthop Relat Res. 1990; (257):226-30. View

Boyanova L . Direct Gram staining and its various benefits in the diagnosis of bacterial infections. Postgrad Med. 2017; 130(1):105-110. DOI: 10.1080/00325481.2018.1398049. View

Deville W, Yzermans J, van Duijn N, Bezemer P, van der Windt D, Bouter L . The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy. BMC Urol. 2004; 4:4. PMC: 434513. DOI: 10.1186/1471-2490-4-4. View

10.

Wyatt M, Beswick A, Kunutsor S, Wilson M, Whitehouse M, Blom A . The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am. 2016; 98(12):992-1000. PMC: 4901182. DOI: 10.2106/JBJS.15.01142. View

11.

Lebovics R, Murthy V, Karmen A . Leukocyte esterase activity in effusion fluid of patients with otitis media. Otolaryngol Head Neck Surg. 1993; 108(3):248-50. DOI: 10.1177/019459989310800307. View

12.

Kaandorp C, Dinant H, van de Laar M, Moens H, Prins A, Dijkmans B . Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997; 56(8):470-5. PMC: 1752430. DOI: 10.1136/ard.56.8.470. View

13.

Margaretten M, Kohlwes J, Moore D, Bent S . Does this adult patient have septic arthritis?. JAMA. 2007; 297(13):1478-88. DOI: 10.1001/jama.297.13.1478. View

14.

Tischler E, Cavanaugh P, Parvizi J . Leukocyte esterase strip test: matched for musculoskeletal infection society criteria. J Bone Joint Surg Am. 2014; 96(22):1917-20. DOI: 10.2106/JBJS.M.01591. View

15.

Mazumder S, Ramya B, Biligi D . Utility of urine reagent strips in cerebrospinal fluid analysis: An aid to bedside diagnosis of meningitis. Indian J Pathol Microbiol. 2018; 61(3):356-359. DOI: 10.4103/IJPM.IJPM_821_16. View

16.

Cooper C, Cawley M . Bacterial arthritis in an English health district: a 10 year review. Ann Rheum Dis. 1986; 45(6):458-63. PMC: 1001917. DOI: 10.1136/ard.45.6.458. View

17.

Omar M, Ettinger M, Reichling M, Petri M, Lichtinghagen R, Guenther D . Preliminary results of a new test for rapid diagnosis of septic arthritis with use of leukocyte esterase and glucose reagent strips. J Bone Joint Surg Am. 2014; 96(24):2032-7. DOI: 10.2106/JBJS.N.00173. View

18.

Perry J, Matthews J, Weesner D . Evaluation of leukocyte esterase activity as a rapid screening technique for bacteriuria. J Clin Microbiol. 1982; 15(5):852-4. PMC: 272201. DOI: 10.1128/jcm.15.5.852-854.1982. View

19.

Colvin O, Kransdorf M, Roberts C, Chivers F, Lorans R, Beauchamp C . Leukocyte esterase analysis in the diagnosis of joint infection: can we make a diagnosis using a simple urine dipstick?. Skeletal Radiol. 2015; 44(5):673-7. DOI: 10.1007/s00256-015-2097-5. View

20.

Soderquist B, Jones I, Fredlund H, Vikerfors T . Bacterial or crystal-associated arthritis? Discriminating ability of serum inflammatory markers. Scand J Infect Dis. 1999; 30(6):591-6. DOI: 10.1080/00365549850161151. View