Should Gram Stains Have a Role in Diagnosing Hip Arthroplasty Infections?

Johnson, Aaron J.; Zywiel, Michael G.; Stroh, D. Alex; Marker, David R.; Mont, Michael A.

doi:10.1007/s11999-009-1216-9

Cited by 33 publications

(18 citation statements)

References 21 publications

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“…results confirm that GS is a diagnostic method with low sensitivity and NLR for the diagnosis of PJI (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Discussionsupporting

confidence: 63%

“…Two additional studies were obtained from one of manuscripts evaluated (12). In summary, 18 articles involving a total of 4,647 patients fulfilled all the inclusion criteria and were considered in the analysis (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…The median number of patients in each study was 169 (range, 33-1,004), and the median age of the participants was 66 years (range, 62-72.8 years). A total of six studies prospectively enrolled patients (5,12,21,22,24,25), and 12 studies were retrospective database reviews (13)(14)(15)(16)(17)(18)(19)(20)23,(26)(27)(28). Patient recruitment was consecutive in five studies (17,21,22,25,27) and was not documented in the remaining 13 studies (5,12-16,18-20, 23,24,26,28).…”

Section: Resultsmentioning

confidence: 99%

“…Patient recruitment was consecutive in five studies (17,21,22,25,27) and was not documented in the remaining 13 studies (5,12-16,18-20, 23,24,26,28). Ten studies detected PJI on the hip and knee (5,12 ,18,19-21,23,24,26,27); three, on the hip (16,22,28); three, on the knee (13,17,25); one, on the elbow (14); and two, on the shoulder (14,21). All the eligible studies scored >9 points using the QUADAS quality assessment tool, indicating that they were of moderate quality.…”

Section: Resultsmentioning

confidence: 99%

“…Gram staining (GS) is a widely used test that is easily available. GS is also commonly used in the diagnosis of PJI, particularly in developing countries, as a result of its low cost, rapid turnaround time and ease of use; however, its value remains controversial due to conflicting results on the effectiveness of GS in the diagnosis of PJI (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The present meta-analysis was therefore performed as one of a series of meta-analyses (6,7,29) in order to evaluate the detection validity of GS for the diagnosis of PJI and to provide evidence-based advice to clinicians.…”

Section: Introductionmentioning

confidence: 99%

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

Ouyang

Zhai

Qin

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The diagnosis of prosthetic joint infection (PJI)following total joint arthroplasty is difficult for clinicians to make decisions due to the similar symptoms presented by aseptic loosening and infection. Gram staining (GS) is a widely used test but its value remains controversial due to conflicting results in the diagnosis of PJI. The aim of the present study was therefore to evaluate the value of GS in the diagnosis of PJI. Searches using MEDLINE, EMBASE and OVID databases were conducted for data published between January 1990 and December 2013. Meta-analysis was used to pool the sensitivity, specificity, diagnostic odd ratios (DORs), area under the receiveroperating characteristic curve (AUC), positive-likelihood ratios (PLRs), negative-likelihood ratios (NLRs) and post-test probability. The heterogeneity and publication bias were assessed, and subgroup and meta-regression analyses were conducted. A total of 18 studies, including a total of 4,647 patients, were selected for analysis. The pooled sensitivity and specificity values for the diagnosis of PJI were 0.19 and 1.00, respectively. The AUC, PLR and NLR were 0.89, 41.6 and 0.82, respectively. Subgroup analyses indicated that the sensitivity/specificity for total hip arthroplasty was 0.14/0.99, whereas that for total knee arthroplasty was 0.14/1.00. Synovial fluid best reflected accurate GS-based diagnoses, with the highest DOR of 242, whereas tissue had the highest AUC of 0.96 (95% CI, 0.94-0.97). GS had a poor clinically acceptable diagnostic value for detecting PJI. These data do not support the routine use of GS, without additional proof of infection, for diagnosing PJI; instead, GS could be used as an adjuvant tool to support the results of other investigations.

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“…results confirm that GS is a diagnostic method with low sensitivity and NLR for the diagnosis of PJI (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Discussionsupporting

confidence: 63%