Stirling Paul, Faroug Radwane, Amanat Suheil, Ahmed Abdulkhaled, Armstrong Malcolm, Sharma Pankaj, Qamruddin Ahmed
Medical School, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
Department of Orthopaedic Surgery, Manchester Royal Infirmary, Manchester M13 9WL, UK.
Int J Microbiol. 2014;2014:830857. doi: 10.1155/2014/830857. Epub 2014 Feb 13.
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.
我们使用滑液革兰氏染色显微镜检查法对脓毒性关节炎的假阴性诊断率进行量化，并将其与同行评审文献中报道的值进行比较。我们提出了一种使用肝素锂容器来防止滑液凝固，从而提高革兰氏染色显微镜检查诊断价值的方法。我们对2003年12月至2012年3月期间接受滑液革兰氏染色和培养的患者的曼彻斯特皇家医院微生物学数据库进行了回顾性研究。在应用排除标准后，最初的1896例疑似脓毒性关节炎的滑液分析队列减少至143例。对我们的革兰氏染色显微镜检查分析显示，在143例滑液培养阳性的队列中，有111例假阴性结果，假阴性率为78%。我们报告脓毒性关节炎革兰氏染色显微镜检查的假阴性率为78%。因此，在有统计学意义的数据集证实其有效性之前，临床医生应避免进行该项检查。使用肝素锂容器收集均匀的滑液样本可以提高该项检查的价值。正在进行的研究旨在确定这能在多大程度上降低假阴性率。
