Fulltext

Gram and acridine orange staining for diagnosis of septic arthritis in different patient populations

Cunningham, Gregory ; Seghrouchni, Khalid ; Ruffieux, Etienne ; Vaudaux, Pierre ; Gayet-Ageron, Angèle ; Cherkaoui, Abdessalam ; Godinho, Eduardo ; Lew, Daniel ; Hoffmeyer, Pierre ; Uçkay, Ilker

In: International Orthopaedics, 2014, vol. 38, no. 6, p. 1283-1290

Add to personal list
    Title
    • Gram and acridine orange staining for diagnosis of septic arthritis in different patient populations
    Author
    • Cunningham, Gregory. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Seghrouchni, Khalid. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Ruffieux, Etienne. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Vaudaux, Pierre. Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
    • Gayet-Ageron, Angèle. Centre of Clinical Research, Geneva University Hospitals, Geneva, Switzerland
    • Cherkaoui, Abdessalam. Laboratory of Microbiology, Geneva University Hospitals, Geneva, Switzerland
    • Godinho, Eduardo. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Lew, Daniel. Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
    • Hoffmeyer, Pierre. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    • Uçkay, Ilker. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • International Orthopaedics, 2014, vol. 38, no. 6, p. 1283-1290. Springer Berlin Heidelberg
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:324738
    Summary
    Purpose: The sensitivity of Gram staining is known to be suboptimal for the diagnosis of native joint septic arthritis. We lack information about the accuracy of Gram compared to other microscopic staining techniques for predicting infection in different patient populations. Methods: This was a cohort study with cost evaluations at the Orthopaedic Service of Geneva University Hospitals (January 1996-October 2012). Results: Among 500 episodes of arthritis (196 with immunosuppression, 227 with underlying arthroplasties and 69 with gout or other crystals in synovial fluid), Gram staining revealed pathogens in 146 episodes (146/500, 29%) or in 146 of the 400 culture-positive episodes (37%). Correlation between the Gram and acridine staining of the same sample was good (Spearman 0.85). Overall, the sensitivity, specificity, positive predictive value and negative predictive value of Gram stain for rapid diagnosis of septic arthritis was 0.37, 0.99, 0.99 and 0.28, respectively, compared to microbiological cultures. Quite similar values were recorded across the different patient subpopulations, in particular for sensitivity values that were 0.33 for patients with prosthetic joint infections, 0.40 for immunosuppressed patients, 0.36 for patients under antibiotic administration and 0.52 for patients with concomitant crystalline disease. Conclusions: The sensitivity of Gram or acridine orange staining for a rapid diagnosis of episodes of septic arthritis is suboptimal compared to microbiological culture, regardless of underlying conditions, immunosuppression or antibiotic therapy. The sensitivity in the presence of synovial fluid crystals is moderate. Acridine orange and Gram stains are equivalent.