ArticleInternational journal of microbiology2014
False-negative rate of gram-stain microscopy for diagnosis of septic arthritis: suggestions for improvement.
Article in International journal of microbiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 38 citations in OpenAlex.
- Diagnostic accuracy of synovial fluid progranulin vs. C-reactive protein in septic arthritis: a comparative biomarker study.Advances in rheumatology (London, England) · 2026Article
- Septic Arthritis Risk Calculator: External Validation of a Prediction Model for Native Adult Knees Among Veterans.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
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- Septic arthritis - symptoms, diagnosis and new therapy.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Review
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- Multi-centre evaluation of Gram stain in the diagnosis of septic arthritis.Journal of bone and joint infection · 2025Article
- The accuracy and diagnostic value of gram staining joint aspirates in suspected joint infections.Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2024Article
- Early postoperative laboratory parameters are predictive of initial treatment failure in acute septic arthritis of the knee and shoulder joint.Scientific reports · 2023Article
- How well does synovial fluid gram staining correlate with cultures in native joint infections?Orthopedic reviews · 2019Article
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- A case report of severely damaged hip joint caused by SAPHO syndrome treated with 2-stage total hip arthroplasty.Medicine · 2016Article
- Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis.Infection & chemotherapy · 2015Article
- Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management.Clinical microbiology reviews · 2015Review
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We quantify the false-negative diagnostic rate of septic arthritis using Gram-stain microscopy of synovial fluid and compare this to values reported in the peer-reviewed literature. We propose a method of improving the diagnostic value of Gram-stain microscopy using Lithium Heparin containers that prevent synovial fluid coagulation. Retrospective study of the Manchester Royal Infirmary microbiology database of patients undergoing synovial fluid Gram-stain and culture between December 2003 and March 2012 was undertaken. The initial cohort of 1896 synovial fluid analyses for suspected septic arthritis was reduced to 143 after exclusion criteria were applied. Analysis of our Gram-stain microscopy yielded 111 false-negative results from a cohort size of 143 positive synovial fluid cultures, giving a false-negative rate of 78%. We report a false-negative rate of Gram-stain microscopy for septic arthritis of 78%. Clinicians should therefore avoid the investigation until a statistically significant data set confirms its efficacy. The investigation's value could be improved by using Lithium Heparin containers to collect homogenous synovial fluid samples. Ongoing research aims to establish how much this could reduce the false-negative rate.
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Registered trials
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