What are the best diagnostic tests for diagnosing bacterial arthritis of a native joint?

Abstract

Aims This study aimed to answer two questions: what are the best diagnostic methods for diagnosing bacterial arthritis of a native joint?; and what are the most commonly used definitions for bacterial arthritis of a native joint? Methods We performed a search of PubMed, Embase, and Cochrane libraries for relevant studies published between January 1980 and April 2020. Of 3,209 identified studies, we included 27 after full screening. Sensitivity, specificity, area under the curve, and Youden index of diagnostic tests were extracted from included studies. We grouped test characteristics per diagnostic modality. We extracted the definitions used to establish a definitive diagnosis of bacterial arthritis of a native joint per study. Results Overall, 28 unique diagnostic tests for diagnosing bacterial arthritis of a native joint were identified. The following five tests were deemed most useful: serum ESR (sensitivity: 34% to 100%, specificity: 23% to 93%), serum CRP (sensitivity: 58% to 100%, specificity: 0% to 96%), serum procalcitonin (sensitivity: 0% to 100%, specificity: 68% to 100%), the proportion of synovial polymorphonuclear cells (sensitivity: 42% to 100%, specificity: 54% to 94%), and the gram stain of synovial fluid (sensitivity: 27% to 81%, specificity: 99% to 100%). Conclusion Diagnostic methods with relatively high sensitivities, such as serum CRP, ESR, and synovial polymorphonuclear cells, are useful for screening. Diagnostic methods with a relatively high specificity, such as serum procalcitonin and synovial fluid gram stain, are useful for establishing a diagnosis of bacterial arthritis. This review helps to interpret the value of various diagnostic tests for diagnosing bacterial arthritis of a native joint in clinical practice. Cite this article: Bone Joint J 2021;103-B(12):1745–1753.

Consensus on the definition and criteria for failure of surgical treatment in bacterial arthritis of a native joint: An international Delphi study

“…This supports the use of systemic sepsis signs to determine the need for reintervention [10]. Serum CRP, with its high sensitivity for diagnosing bacterial arthritis, is a valuable screening test [6]. The baseline CRP level (i.e., preoperation) can serve as a benchmark to assess infection improvement or deterioration.…”

“…Patients with bacterial arthritis may require reinterventions, with a reported failure rate of approximately 26% in the literature [2]. Diagnosis is challenging due to the lack of clear standards and unreliable tests, making it even more difficult to determine if reintervention is necessary [6]. Failure to perform a reintervention in patients with persistent bacterial arthritis can lead to serious consequences, such as: joint damage, sepsis, the need for additional surgery, and even dead [7].…”

“…In contrast, bacterial arthritis cannot be ruled out, even with negative joint cultures, given their less than 100% sensitivity and potential for false negatives [9]. Blood cultures can complement inconclusive synovial fluid cultures, aiding in identifying the causative organism, and making them valuable for reintervention decisions in bacterial arthritis [6,14].…”

Needle Arthroscopy for Bacterial Arthritis of a Native Joint: Surgical Technique for the Shoulder, Elbow, Wrist, Knee, and Ankle Under Local Anesthesia

“…1 However, the diagnosis of bacterial arthritis is difficult and relies on diagnostic tests with poor-to-moderate accuracy (i.e., specificity and sensitivity). 2 This results in a practice in which a high threshold for surgery poses a risk of undertreatment for true positives and a low threshold for surgery will result in an unnecessarily invasive and costly procedure for false positives.Needle arthroscopy under local anesthesia has been proposed as a treatment modality for native joint bacterial arthritis that can be performed directly upon presentation at the patient's bedside, in the emergency department, or in the outpatient clinic. 3 In a minimally invasive manner, it may address true-positive patients in a timely fashion yet decrease the burden of overtreatment for false-positive cases.Compared with conventional arthroscopy, needle arthroscopy has various differences.…”

“… 1 However, the diagnosis of bacterial arthritis is difficult and relies on diagnostic tests with poor-to-moderate accuracy (i.e., specificity and sensitivity). 2 This results in a practice in which a high threshold for surgery poses a risk of undertreatment for true positives and a low threshold for surgery will result in an unnecessarily invasive and costly procedure for false positives.…”