Reply

To the Editor,

Re: Gautam et al. Effectiveness of leucocyte esterase as a diagnostic test for acute septic arthritis J Orthopaedic Surgery, published January 2017, 25(1). DOI: 10.1177/2309499016685019

We are thankful to the author of ‘Letter to the Editor’ for his readership and keen interest in our article.

We would like to reassert that, one of the limitations we faced was constraints in the time available for conducting the study. ¹ No evaluation was done for interferences in the diagnostic test but it has already been mentioned that bloody aspirate interferes with the colorimetric test like leukocyte esterase. ² To avoid error in testing and reading of each strip, two strips were used for each patient and intra observer reliability was 0.67. ¹ Adams considered Multistix test as neither cost effective nor clinically useful but their conclusion was based on comparison of Multistix test and refractometry for urine specific gravity. ³ The each strip we used costed INR 15 and the sensitivity and negative predictive value was 100%, the strip test was positive even in the patients which were gram stain negative but culture positive, that’s why we consider it as a cost effective test. ¹ We have come across several other studies whose findings correlate with ours. This test is also being applied for the detection of periprosthetic joint infections. ^2,4,5

Siddharth Sharma, Rishabh Saini and Virender Kumar Gautam Maulana Azad Medical College, New Delhi, India