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Ascitic fluid TREM-1 for the diagnosis of spontaneous bacterial peritonitis
  1. L Ichou1,
  2. N Carbonell2,
  3. P E Rautou3,4,
  4. L Laurans4,
  5. S Bourcier1,5,
  6. C Pichereau1,5,
  7. J L Baudel1,
  8. J B Nousbaum6,
  9. C Renou7,
  10. R Anty8,
  11. J Tankovic9,
  12. E Maury1,5,
  13. B Guidet1,5,
  14. L Landraud10,
  15. H Ait-Oufella1,4,5
  1. 1Service de réanimation médicale, AP-HP, Hôpital Saint-Antoine, Paris, France
  2. 2Service d'hépatologie, AP-HP, Hôpital Saint-Antoine, Paris, France
  3. 3DHU UNITY, Service d'hépatologie, Hôpital Beaujon, Clichy, France
  4. 4Inserm U970, Paris Research Cardiovascular Center, Paris, France
  5. 5Université Pierre et Marie Curie-Paris 6, Paris, France
  6. 6Service d'Hépato-Gastro-Entérologie, CHU Brest, Brest, France
  7. 7Unité d'Hospitalisation de Jour pluridisciplinaire, CHR Hyeres, Hyeres, France
  8. 8Service d'Hépato-Gastro-Entérologie, CHU Nice Sophia Antipolis, Nice, France
  9. 9Service de Bactériologie, AP-HP, Hôpital Saint-Antoine, Paris, France
  10. 10Service de Bactériologie CHU Nice Sophia Antipolis, France
  1. Correspondence to Professor Hafid Ait-Oufella, Service de réanimation médicale, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris cedex 12, France; hafid.aitoufella{at}sat.aphp.fr

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We read with interest the study by Knoop et al1 who reported deleterious effects of antibiotics on the intestinal microflora. This observation should motivate the development of powerful tools for the diagnosis of infections to limit inappropriate antibiotic prescription. Spontaneous bacterial peritonitis (SBP) in patients with cirrhosis2 is a frequent life-threatening complication3 whose diagnosis is based on manual ascitic polymorphonuclear (PMN) count higher than 250 cells/μL.4 However, manual measurement of PMN count is operator dependent, makes quality control difficult and can delay the diagnosis.5 Recently, we have evaluated the validity and utility of ascitic fluid triggering receptors expressed on myeloid cells-1 (TREM-1) levels for the diagnosis of SBP. TREM-1 for triggering receptors expressed on myeloid cells-16 is a receptor expressed and released by innate inflammatory cells after exposure to bacteria membrane components.7

From February to October 2014, we prospectively included in a test cohort all consecutive patients older than 18 years with cirrhosis admitted to two departments of hepatology and one intensive care …

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