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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 4, issue 2
J. Bone Joint Infect., 4, 56–59, 2019
© Author(s) 2019. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 4, 56–59, 2019
© Author(s) 2019. This work is distributed under
the Creative Commons Attribution 4.0 License.

Brief report 29 Jan 2019

Brief report | 29 Jan 2019

Is Gram staining still useful in prosthetic joint infections?

Marjan Wouthuyzen-Bakker1, Noam Shohat2,3, Marine Sebillotte4, Cédric Arvieux4,5, Javad Parvizi2, and Alex Soriano6 Marjan Wouthuyzen-Bakker et al.
  • 1Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, the Netherlands.
  • 2Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States.
  • 3Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel.
  • 4Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.
  • 5Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France.
  • 6Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.

Keywords: Prosthetic joint infection, acute, hematogenous, Gram staining, Staphylococcus aureus

Abstract. Introduction: Staphylococcus aureus 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 S. aureus PJI.

Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. 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.

Results: 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).

Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.

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