Evidence map›Paper›PMID 26136905›Full record

ArticleExperimental and therapeutic medicine2015

Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty.

Zhengxiao Ouyang, Zanjing Zhai, A N Qin, Haowei Li, Xuqiang Liu, Xinhua Qu, Kerong Dai

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Experimental and therapeutic medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 3 pooled it
1.2field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 3 syntheses or guidelines pooled it, 22 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Article
  6. Article
  7. Review
  8. Article
  9. Is Gram staining still useful in prosthetic joint infections?Journal of bone and joint infection · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Zhengxiao OuyangDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China ; Department of Orthopedics, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, P.R. China.
Zanjing ZhaiDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China.
A N QinDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China.
Haowei LiDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China.
Xuqiang LiuDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China.
Xinhua QuDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China.
Kerong DaiDepartment of Orthopedics, Shanghai Key Laboratory of Orthopedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Hunan, P.R. China.
Shanghai Ninth People's Hospital · CN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The diagnosis of prosthetic joint infection (PJI) following total joint arthroplasty is difficult for clinicians to make decisions due to the similar symptoms presented by aseptic loosening and infection. Gram staining (GS) is a widely used test but its value remains controversial due to conflicting results in the diagnosis of PJI. The aim of the present study was therefore to evaluate the value of GS in the diagnosis of PJI. Searches using MEDLINE, EMBASE and OVID databases were conducted for data published between January 1990 and December 2013. Meta-analysis was used to pool the sensitivity, specificity, diagnostic odd ratios (DORs), area under the receiver-operating characteristic curve (AUC), positive-likelihood ratios (PLRs), negative-likelihood ratios (NLRs) and post-test probability. The heterogeneity and publication bias were assessed, and subgroup and meta-regression analyses were conducted. A total of 18 studies, including a total of 4,647 patients, were selected for analysis. The pooled sensitivity and specificity values for the diagnosis of PJI were 0.19 and 1.00, respectively. The AUC, PLR and NLR were 0.89, 41.6 and 0.82, respectively. Subgroup analyses indicated that the sensitivity/specificity for total hip arthroplasty was 0.14/0.99, whereas that for total knee arthroplasty was 0.14/1.00. Synovial fluid best reflected accurate GS-based diagnoses, with the highest DOR of 242, whereas tissue had the highest AUC of 0.96 (95% CI, 0.94-0.97). GS had a poor clinically acceptable diagnostic value for detecting PJI. These data do not support the routine use of GS, without additional proof of infection, for diagnosing PJI; instead, GS could be used as an adjuvant tool to support the results of other investigations.

Indexed as

Gram stainingmeta-analysisprosthetic joint infectiontotal hip arthroplastytotal knee arthroplasty

Identifiers

PMID26136905
PMCPMC4471807
OpenAlexW2063534626

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.