Is Gram staining still useful in prosthetic joint infections?
<p class="p p-first" id="__p2"><strong>Introduction</strong>: <em>Staphylococcus aureus</em> is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorga...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Copernicus Publications
2019-01-01
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| Series: | Journal of Bone and Joint Infection |
| Online Access: | https://jbji.copernicus.org/articles/4/56/2019/jbji-4-56-2019.pdf |
| _version_ | 1831679627704139776 |
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| author | M. Wouthuyzen-Bakker N. Shohat N. Shohat M. Sebillotte C. Arvieux C. Arvieux J. Parvizi A. Soriano |
| author_facet | M. Wouthuyzen-Bakker N. Shohat N. Shohat M. Sebillotte C. Arvieux C. Arvieux J. Parvizi A. Soriano |
| author_sort | M. Wouthuyzen-Bakker |
| collection | DOAJ |
| description | <p class="p p-first" id="__p2"><strong>Introduction</strong>: <em>Staphylococcus aureus</em> is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute <em>S. aureus</em> PJI.</p><p id="__p3"><strong>Material and methods</strong>: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to <em>S. aureus</em>. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.</p><p id="__p4"><strong>Results</strong>: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).</p><p class="p p-last" id="__p5"><strong>Conclusion</strong>: Gram staining may be a useful diagnostic tool in late acute PJI to identify <em>S. aureus</em> PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.</p> |
| first_indexed | 2024-12-20T05:22:49Z |
| format | Article |
| id | doaj.art-8e198f5ab3a44487bfb039e6cb31c968 |
| institution | Directory Open Access Journal |
| issn | 2206-3552 |
| language | English |
| last_indexed | 2024-12-20T05:22:49Z |
| publishDate | 2019-01-01 |
| publisher | Copernicus Publications |
| record_format | Article |
| series | Journal of Bone and Joint Infection |
| spelling | doaj.art-8e198f5ab3a44487bfb039e6cb31c9682022-12-21T19:51:57ZengCopernicus PublicationsJournal of Bone and Joint Infection2206-35522019-01-014565910.7150/jbji.31312Is Gram staining still useful in prosthetic joint infections?M. Wouthuyzen-Bakker0N. Shohat1N. Shohat2M. Sebillotte3C. Arvieux4C. Arvieux5J. Parvizi6A. Soriano7Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, the Netherlands.Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States.Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel.Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France.Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States.Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.<p class="p p-first" id="__p2"><strong>Introduction</strong>: <em>Staphylococcus aureus</em> is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute <em>S. aureus</em> PJI.</p><p id="__p3"><strong>Material and methods</strong>: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to <em>S. aureus</em>. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.</p><p id="__p4"><strong>Results</strong>: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).</p><p class="p p-last" id="__p5"><strong>Conclusion</strong>: Gram staining may be a useful diagnostic tool in late acute PJI to identify <em>S. aureus</em> PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.</p>https://jbji.copernicus.org/articles/4/56/2019/jbji-4-56-2019.pdf |
| spellingShingle | M. Wouthuyzen-Bakker N. Shohat N. Shohat M. Sebillotte C. Arvieux C. Arvieux J. Parvizi A. Soriano Is Gram staining still useful in prosthetic joint infections? Journal of Bone and Joint Infection |
| title | Is Gram staining still useful in prosthetic joint infections? |
| title_full | Is Gram staining still useful in prosthetic joint infections? |
| title_fullStr | Is Gram staining still useful in prosthetic joint infections? |
| title_full_unstemmed | Is Gram staining still useful in prosthetic joint infections? |
| title_short | Is Gram staining still useful in prosthetic joint infections? |
| title_sort | is gram staining still useful in prosthetic joint infections |
| url | https://jbji.copernicus.org/articles/4/56/2019/jbji-4-56-2019.pdf |
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