J Bone Jt Infect 2019; 4(2):56-59. doi:10.7150/jbji.31312

Short Research Communication

Is Gram staining still useful in prosthetic joint infections?

Marjan Wouthuyzen-Bakker1✉, Noam Shohat2,3, Marine Sebillotte4, Cédric Arvieux4,5, Javad Parvizi2, Alex Soriano6

1. Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, the Netherlands.
2. Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, United States.
3. Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel.
4. Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.
5. Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France.
6. Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.


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.

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

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How to cite this article:
Wouthuyzen-Bakker M, Shohat N, Sebillotte M, Arvieux C, Parvizi J, Soriano A. Is Gram staining still useful in prosthetic joint infections?. J Bone Jt Infect 2019; 4(2):56-59. doi:10.7150/jbji.31312. Available from http://www.jbji.net/v04p0056.htm