Journal of Bone and Joint Infection
Journal of Bone and Joint Infection
JBJI
Articles | Volume 10, issue 2
Articles | Volume 10, issue 2
https://doi.org/10.5194/jbji-10-61-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-61-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
Articles | Volume 10, issue 2
Original full-length article
 | 
17 Mar 2025
Original full-length article |  | 17 Mar 2025

Multi-centre evaluation of Gram stain in the diagnosis of septic arthritis

Charlotte Smith, Robert J. Maloney, Deborah Wearmouth, Hemant Sharma, Kordo Saeed, Nusreen Ahmad-Saeed, Rachel Annett, Lucinda Barrett, Sara E. Boyd, Peter Davies, Harriet Hughes, Gwennan Jones, Laura Leach, Maureen Lynch, Deepa Nayar, Martin Marsh, Shanine Mitchell, Lynn Moffat, Luke S. P. Moore, Michael E. Murphy, Shaan Ashk O'Shea, Teresa Peach, Christina Petridou, Niamh Reidy, Ben Talbot, Catherine Aldridge, and Gavin Barlow

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More articles (3)

Cited articles

Al-Tawil, K., Quiney, F., Pirkis, L., Birkett, N., and Rooney, A.: Gram stain microscopy in septic arthritis, Acta Orthop. Belg., 87, 553–556, 2021. 
Arieli, M. M., Fowler, M. L., Lieber, S. B., Shmerling, R. H., and Paz, Z.: The profile of the causative organisms which lead to septic arthritis of native joints over the last two decades in a single tertiary medical center in the east coast of the United States, Int. J. Clin. Pract., 75, e15003, https://doi.org/10.1111/ijcp.15003, 2021. 
Bram, J. T., Baldwin, K. D., and Blumberg, T. J.: Gram Stain is Not Clinically Relevant in Treatment of Pediatric Septic Arthritis, J. Pediatr. Orthop., 38, e536–e540, https://doi.org/10.1097/BPO.0000000000001226, 2018. 
Coakley, G., Mathews, C., Field, M., Jones, A., Kingsley, G., Walker, D., Phillips, M., Bradish, C., McLachlan, A., Mohammed, R., and Weston, V.: British Society for Rheumatology Standards, Guidelines and Audit Working Group, BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults, Rheumatology, 8, 1039–1041, https://doi.org/10.1093/rheumatology/kel163a, 2006.  
Cunningham, G., Seghrouchni, K., Ruffieux, E., Vaudaux, P., Gayet-Ageron, A., Cherkaoui, A., Godinho, E., Lew, D., Hoffmeyer, P., and Uçkay, I.: Gram and acridine orange staining for diagnosis of septic arthritis in different patient populations, Int. Orthop., 38, 1283–1290, https://doi.org/10.1007/s00264-014-2284-3, 2014. 
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Urgent analysis of joint fluid is a common test in patients with possible septic arthritis (bacterial infection of a joint). One aspect of this test, called the Gram stain, is considered important clinically, but previous single hospital studies have suggested it will miss a considerable number of infections. This large multi-hospital UK study assessed this test and found that it will miss 73 % of infections, questioning its value. More research on rapid tests using new technologies is required.
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