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Clinical Chemistry 53: 1855-1857, 2007. First published August 23, 2007; 10.1373/clinchem.2007.089482
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(Clinical Chemistry. 2007;53:1855-1857.)
© 2007 American Association for Clinical Chemistry, Inc.

Technical Briefs

Postcollection Synthesis of Ethyl Glucuronide by Bacteria in Urine May Cause False Identification of Alcohol Consumption

Anders Helandera, Ingrid Olsson and Helen Dahl

Department of Clinical Neuroscience, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden

aaddress correspondence to this author at: Alcohol Laboratory, L7:03, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; fax 46-8-51771532, e-mail anders.helander{at}ki.se


Abstract

Background: Ethyl glucuronide (EtG) is a minor ethanol metabolite used as a specific marker to document recent alcohol consumption; confirm abstinence in treatment programs, workplaces, and schools; and provide legal proof of drinking. This study examined if bacterial pathogens in urine may enable postsampling synthesis of EtG and ethyl sulfate (EtS) from ethanol, leading to clinical false-positive results.

Methods: Urine specimens with confirmed growth of Escherichia coli, Klebsiella pneumoniae, or Enterobacter cloacae were stored at room temperature in the presence of ethanol. Ethanol was either added to the samples or generated by inoculation with the fermenting yeast species Candida albicans and glucose as substrate. EtG and EtS were measured by LC-MS.

Results: High concentrations of EtG (24-h range 0.5–17.6 mg/L) were produced during storage in 35% of E. coli-infected urines containing ethanol. In some specimens that were initially EtG positive because of recent alcohol consumption, EtG was also sensitive to degradation by bacterial hydrolysis. In contrast, EtS was completely stable under these conditions.

Conclusions: The presence of EtG in urine is not a unique indicator of recent drinking, but might originate from postcollection synthesis if specimens are infected with E. coli and contain ethanol. Given the associated risks for false identification of alcohol consumption and false-negative EtG results due to bacterial degradation, we recommend that measurement of EtG be combined with EtS, or in the future possibly replaced by EtS.




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A. Helander, M. Bottcher, C. Fehr, N. Dahmen, and O. Beck
Detection Times for Urinary Ethyl Glucuronide and Ethyl Sulfate in Heavy Drinkers during Alcohol Detoxification
Alcohol Alcohol., January 1, 2009; 44(1): 55 - 61.
[Abstract] [Full Text] [PDF]


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