Uropathogens Causing False Negative Urinary EtG

Following ethanol ingestion, the majority of ethanol (95-98%) is eliminated in the liver by conversion first to acetaldehyde by ADH and then to acetic acid by aldehyde dehydrogenase. A very small fraction of ingested ethanol (<0.1%) is converted to EtG and ethyl sulfate (EtS) by uridine-diphosphate-glucuronyltransferase and sulfo-transferase, respectively (41,42). Because both EtG and EtS have longer elimination times than ethanol (42), a positive result of EtG and/or EtS indicates that the person was recently drinking ethanol, even if ethanol concentration is no longer detected.

EtG, but not EtS, is cleaved by ^-glucuronidase, an enzyme that is found in most strains of E. coli (23). E. coli is the predominant pathogen responsible for almost 80% of urinary tract infections (43). Helander and Dahl (44) reported that EtG may not be stable if urine specimens are infected with microorganisms possessing ^-glucuronidase activity. However, EtS was found to be stale to bacterial hydrolysis. Therefore, refrigeration or freezing of specimens or use of fluoride preservative is necessary to prevent bacterial growth and reduce EtG hydrolysis.

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