The accuracy and diagnostic value of gram staining joint aspirates in suspected joint infections.

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-07-01 Epub Date: 2024-02-27 DOI:10.1177/11207000241230927
James Zhang, Anna Stevenson, Andrew Kailin Zhou, Faris Khan, Rahul Geetala, Matija Krkovic
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引用次数: 0

Abstract

Background: Septic arthritis is a debilitating condition with prolonged treatment and adverse outcomes. A gram stain is often performed from the joint aspirate sample, followed by a definitive culture. In our study, we assessed the accuracy of gram staining for suspected septic arthritis and explored factors associated with positive culture growth and false negatives in the gram stain.

Methods: We retrospectively reviewed joint aspirates performed from 2015-2021 at a major trauma centre. Aspirates not cultured for septic arthritis were excluded. Data collected included aspirate site, gram stain and culture result delay, patient demographics, orthopaedic/rheumatological history, and comorbidities. Outcomes measured were gram stain sensitivity and specificity. Factors influencing positive cultures and false negative gram stain results were analysed using logistic regression.

Results: Of 408 joint aspirates meeting the criteria, 37 did not undergo initial gram staining. Gram stain sensitivity was 30.4%, specificity was 97.6%. The delay from aspirate to definitive gram stain and culture results was 1.1 and 5.4 days, respectively Logistic regression identified that prosthetic joint(p = 0.007), past joint infections(p = 0.006), arthritis(p < 0.001), hypertension(p = 0.007), diabetes(p = 0.019) were positively associated with positive cultures. Past joint infections(p = 0.004) were positively associated with false negative gram stain results. Patients on antibiotics during the aspirate had a higher risk of false negative gram stain results (OR = 5.538, 95%CI, 2.802-10.948; p < 0.001).

Conclusions: In conclusion, the initial gram stain has limited sensitivity and caution should be exercised when interpreting negative results. Vigilance is crucial when the highlighted comorbidities or antibiotic use are present, to assess patients with potential joint infections.

对疑似关节感染的关节抽吸物进行革兰氏染色的准确性和诊断价值。
背景:化脓性关节炎是一种使人衰弱的疾病,治疗时间长,结果不良。通常先对关节抽吸样本进行革兰氏染色,然后进行确证培养。在我们的研究中,我们评估了对疑似化脓性关节炎进行革兰氏染色的准确性,并探讨了与革兰氏染色培养阳性生长和假阴性相关的因素:我们对一家大型创伤中心 2015-2021 年期间进行的关节穿刺进行了回顾性分析。未培养出化脓性关节炎的抽吸物被排除在外。收集的数据包括抽吸部位、革兰氏染色和培养结果延迟、患者人口统计学、骨科/风湿病史和合并症。测量结果为革兰氏染色敏感性和特异性。采用逻辑回归分析了影响阳性培养和假阴性革兰氏染色结果的因素:在符合标准的 408 例关节抽吸物中,37 例未进行初步革兰氏染色。革兰氏染色敏感性为 30.4%,特异性为 97.6%。逻辑回归结果显示,假肢关节(p = 0.007)、既往关节感染(p = 0.006)、关节炎(p = 0.007)、糖尿病(p = 0.019)与阳性培养呈正相关。既往关节感染(p = 0.004)与革兰氏染色假阴性结果呈正相关。在抽吸过程中使用抗生素的患者出现革兰氏染色假阴性结果的风险较高(OR = 5.538,95%CI,2.802-10.948;p):总之,初始革兰氏染色的灵敏度有限,在解释阴性结果时应谨慎。当存在突出的合并症或使用抗生素时,必须保持警惕,以评估潜在的关节感染患者。
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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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