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

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Abstract

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.

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Acknowledgments

We thank the Orthopaedic Service and the various laboratories for their support.

Conflict of interest

There are no financial supports or other benefits from commercial sources for the work reported on in the manuscript, or any other financial interests that any of the authors may have, which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work. Parts of the manuscript have been presented as posters and short presentations at the Swiss National Congresses for Infectiology (Lugano, June 2013) and Orthopaedic Surgery (Lausanne, June 2013).

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Authors and Affiliations

  1. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Gregory Cunningham, Khalid Seghrouchni, Etienne Ruffieux, Eduardo Godinho, Pierre Hoffmeyer & Ilker Uçkay

  2. Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland

    Pierre Vaudaux, Daniel Lew & Ilker Uçkay

  3. Centre of Clinical Research, Geneva University Hospitals, Geneva, Switzerland

    Angèle Gayet-Ageron

  4. Laboratory of Microbiology, Geneva University Hospitals, Geneva, Switzerland

    Abdessalam Cherkaoui

Authors
  1. Gregory Cunningham
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  2. Khalid Seghrouchni
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  3. Etienne Ruffieux
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  4. Pierre Vaudaux
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  5. Angèle Gayet-Ageron
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  6. Abdessalam Cherkaoui
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  7. Eduardo Godinho
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  8. Daniel Lew
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  9. Pierre Hoffmeyer
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  10. Ilker Uçkay
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Corresponding author

Correspondence to Ilker Uçkay.

Additional information

Gregory Cunningham and Khalid Seghrouchni contributed equally as first authors.

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Cunningham, G., Seghrouchni, K., Ruffieux, E. et al. Gram and acridine orange staining for diagnosis of septic arthritis in different patient populations. International Orthopaedics (SICOT) 38, 1283–1290 (2014). https://doi.org/10.1007/s00264-014-2284-3

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  • DOI: https://doi.org/10.1007/s00264-014-2284-3

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