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In vivo Macrophage Imaging Using MR Targeted Contrast Agent for Longitudinal Evaluation of Septic Arthritis

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Published on: October 20, 2013

Gram stain microscopy in septic arthritis.

Karam Al-Tawil, Frederick Quiney, Louis Pirkis

Acta Orthopaedica Belgica

|November 22, 2021

Summary

Gram stain is a rapid diagnostic test for septic arthritis but has low sensitivity (22%). Clinicians should rely more on clinical findings and biochemical markers due to potential false negatives in diagnosing joint infections.

Area of Science:

Orthopedics
Infectious Diseases
Microbiology
Diagnostic Pathology

Background:

Septic arthritis is a severe joint infection requiring prompt diagnosis and treatment to prevent rapid joint destruction.
Annual incidence is 10 per 100,000, rising to 70 per 100,000 in at-risk populations (e.g., rheumatoid arthritis, immunocompromised patients).
Gram stain is a common initial diagnostic test for suspected septic arthritis.

Purpose of the Study:

To evaluate the clinical utility of Gram stain for diagnosing septic arthritis.
To determine the sensitivity and specificity of Gram stain in identifying septic arthritis.
To assess the impact of Gram stain results on clinical decision-making for joint infections.

Main Methods:

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Retrospective case series analysis of joint aspirates from May 2015 to April 2018 at a single center.

Inclusion of 830 samples from both native (701 cases) and prosthetic (129 cases) joints.

Comparison of Gram stain results with final culture results for all analyzed samples.

Main Results:

A discrepancy between Gram stain and culture results was observed in 74 cases (9%).
The sensitivity of Gram stain for detecting septic arthritis was found to be 22%.
The specificity of Gram stain was high, recorded at 99.6%.

Conclusions:

Gram stain demonstrates low sensitivity in diagnosing septic arthritis, indicating a high rate of false negatives.
Despite low sensitivity, Gram stain exhibits high specificity, meaning positive results are generally reliable.
Clinicians should maintain a low threshold for considering septic arthritis even with negative Gram stain results, emphasizing clinical presentation and biochemical markers.