Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

Ouyang, Zhengxiao; Zhai, Zanjing; Qin, An; Li, Haowei; Liu, Xuqiang; Qu, Xinhua; Dai, Kerong

doi:10.3892/etm.2015.2315

Cited by 18 publications

(12 citation statements)

References 46 publications

(122 reference statements)

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“…To elaborate, studies have shown that Gram staining of synovial fluid has a poor sensitivity in diagnosing PJI, but its value is mostly evaluated in chronic cases, and may be more useful and sensitive in acute infections. 18 Unfortunately, early molecular detection does not show any benefit so far in acute PJIs, but its diagnostic accuracy maybe optimized in upcoming years. 19 For late acute PJIs caused by another microorganism than S. aureus , the CRIME80 score could be useful in identifying high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Wouthuyzen-Bakker

Sebillotte

Lomas

et al. 2019

Journal of Infection

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Section: Discussionmentioning

confidence: 99%

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Wouthuyzen-Bakker

Sebillotte

Lomas

et al. 2019

Journal of Infection

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“…In the past decade, several meta-analyses have been performed to assess the diagnostic accuracy of various established tests for PJI detection (Table 3 and Fig. 5 ) 9 , 10 , 32 – 43 . Traditionally, periprosthetic tissue culture, which has a positive detection rate of 0.70–0.90, is regarded as the gold standard test for PJI diagnosis 8 , 44 – 46 .…”

Section: Discussionmentioning

confidence: 99%

“… 42 0.80 (0.74–0.84) 0.95 (0.90–0.98) 17.20 (7.60–38.70) 0.21 (0.17–0.27) 81.00 (35.00–186.00) 0.89 (0.86–0.91) Gram staining Ouyang et al . 43 0.19 (0.12–0.27) 1.00 (0.99–1.00) 41.60 (15.50–111.20) 0.82 (0.75–0.89) 51.00 (18.00–140.00) 0.89 (0.86–0.91) If one diagnostic method was reported by more than one meta-analyses, the most detailed and/or recent one was included in Table 3 . ESR: Erythrocyte sedimentation rate; FDG-PET: 18F-fluoro-2-deoxyglucose positron emission tomography.…”

Section: Discussionmentioning

confidence: 99%

Serum and Synovial Fluid Interleukin-6 for the Diagnosis of Periprosthetic Joint Infection

Xie

Dai

et al. 2017

Sci Rep

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Periprosthetic joint infection (PJI) is a severe complication of arthroplasty and causes unrelieved pain and joint dysfunction. Although standardised perioperative management has lowered the risk of hip and knee PJI to less than 2%, PJI is still a significant cause of revision surgery [1][2][3][4][5] . In contrast to aseptic loosening, PJI is often associated with a two-stage revision procedure and long-term antibiotic therapy. Given these adverse implications, an accurate diagnosis method for PJI is valuable in arthroplasty surgery. In the past decades, various diagnostic methods and guidelines have been established for diagnosing PJI. Unfortunately, in the absence of a gold standard test, it is still challenging to differentiate PJI from aseptic loosening 6 . A previous prospective cohort study reported that 25% of PJI patients were misdiagnosed with aseptic loosening in the first year after arthroplasty 7 . Periprosthetic tissue culture and histological examination are reliable diagnostic methods for PJI detection 8 ; however, neither method can guide the operative decision before revision surgery.Inflammatory biomarkers in the serum and synovial fluid can be evaluated before surgery 8 . Traditional biomarkers such as serum white cell count (WCC) and C-reactive protein (CRP) have limited diagnostic accuracy for PJI detection 9,10 . Previous meta-analysis indicated that the sensitivity of serum WCC for PJI detection is 0.45 9 . The pooled sensitivity and specificity of serum CRP are 0.82 and 0.77, respectively 10 . Recently, the diagnostic value of interleukin-6 (IL-6) for PJI detection was investigated. IL-6 is produced by lymphoid and non-lymphoid cells, and it participates in the inflammatory response 11 . Serum IL-6 levels increase with trauma, infection, and surgery [11][12][13] . In patients with aseptic prosthetic loosening, IL-6 levels decrease to the normal level within 48 h after arthroplasty 13 . However, following infection, IL-6 activates the release of CRP 14 . Therefore, the increase of IL-6 precedes that of CRP after infection; thus, IL-6 may be a more sensitive marker for PJI.The previous meta-analysis summarised the results of three studies and showed that high serum IL-6 level strongly indicates PJI 9 . Following this study, the diagnostic capacity of serum and synovial fluid IL-6 for PJI has been widely evaluated; however, there were some discrepancies in the results [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . The objective of the present meta-analysis was to estimate the value of serum and synovial fluid IL-6 assessments for PJI diagnosis. ResultsSearch Results. A total 323 articles were identified following the database and bibliography search. After further screening, 257 articles were excluded, and 33 articles were excluded after full-text evaluation (Fig. 1).

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“…Although Gram-staining can be easily used in identifying Gram-positive and Gram-negative bacteria, their results require examination via optical microscopy. Furthermore, false-positive Gram-staining results may be obtained because of high decolorization, excessive heat during fixation, insufficient crystal violet concentration, and Gram-staining-resistant bacteria [ 23 , 24 , 25 ]. Moreover, it is usually recommended that bacteria should be freshly harvested from overnight or extended 18–48 h cultures before Gram-staining [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

Rapid Detection of Pathogenic Bacteria by the Naked Eye

2021

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Escherichia coli O157:H7 and Staphylococcus aureus are common pathogens. Gram-negative bacteria, such as E. coli, contain high concentrations of endogenous peroxidases, whereas Gram-positive bacteria, such as S. aureus, possess abundant endogenous catalases. Colorless 3,5,3′,5′-tetramethyl benzidine (TMB) changes to blue oxidized TMB in the presence of E. coli and a low concentration of H2O2 (e.g., ~11 mM) at pH of 3. Moreover, visible air bubbles containing oxygen are generated after S. aureus reacts with H2O2 at a high concentration (e.g., 180 mM) at pH of 3. A novel method for rapidly detecting the presence of bacteria on the surfaces of samples, on the basis of these two endogenous enzymatic reactions, was explored. Briefly, a cotton swab was used for collecting bacteria from the surfaces of samples, such as tomatoes and door handles, then two-step endogenous enzymatic reactions were carried out. In the first step, a cotton swab containing bacteria was immersed in a reagent comprising H2O2 (11.2 mM) and TMB for 25 min. In the second step, the swab was dipped further in H2O2 (180 mM) at pH 3 for 5 min. Results showed that the presence of Gram-negative bacteria, such as E. coli with a cell number of ≥ ~105, and Gram-positive bacteria, such as S. aureus with a cell number of ≥ ~106, can be visually confirmed according to the appearance of the blue color in the swab and the formation of air bubbles in the reagent solution, respectively, within ~30 min. To improve visual sensitivity, we dipped the swab carrying the bacteria in a vial containing a growth broth, incubated it for ~4 h, and carried out the two-stage reaction steps. Results showed that bluish swabs resulting from the presence of E. coli O157: H7 with initial cell numbers of ≥ ~34 were obtained, whereas air bubbles were visible in the samples containing S. aureus with initial cell numbers of ≥ ~8.5 × 103.

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Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

Cited by 18 publications

References 46 publications

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Serum and Synovial Fluid Interleukin-6 for the Diagnosis of Periprosthetic Joint Infection

Rapid Detection of Pathogenic Bacteria by the Naked Eye

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