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We read with interest the study by Knoop et al 1 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-1 6 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 …
Contributors Study concept and design: HA-O, BG and EM. Acquisition of data: LI, NC, PER, CP, SB and JBN. Analysis and interpretation of data: LI, LL, HA-O. Drafting of the manuscript; critical revision of the manuscript for important intellectual content: HA-O, LI, NC, PER, JT, BG and EM. Statistical analysis: HA-O and LI. Study supervision: HA-O. RA, CR, JBN and LL: designed and built the independent validation biobank.
Funding The validation cohort was obtained from study supported by the French Ministry of Health (PHRC).
Competing interests HA-O applied a patent on the measurement of ascitic fluid TREM-1 concentration for SBP diagnosis.
Ethics approval This study was approved by the ethical committee, Comité de Protection des Personnes (Saint-Louis Hospital, Paris, France) and verbal consent was obtained from all patients or their families. The requirement for written consent was waived by the institutional review board.
Provenance and peer review Not commissioned; internally peer reviewed.