Acute Bacterial Arthritis and Waiting for Culture Results
We performed a retrospective cohort study designed to determine the positivity rate and time to positivity of synovial fluid cultures from adult inpatients with suspected acute bacterial arthritis.
The records of all patients 18 years or older who were admitted in Albert Einstein Medical Center from December 10, 2010, to September 18, 2013, for joint complaints and had a synovial fluid culture were screened for the study. Cases of patients with acute (onset within the previous 2 weeks) monoarthritis with a synovial fluid specimen sent for Gram stain and culture were classified as suspected acute bacterial arthritis. Patients with disseminated gonococcal disease were excluded. Subjects were then classified as high risk or low risk for acute bacterial arthritis. High-risk patients had any 1 of the following: age at least 80 years old, rheumatoid arthritis, osteoarthritis, diabetes mellitus, active malignancy, chemotherapy or immunosuppressant therapy, joint prosthesis in the affected joint, peripheral leukopenia (<4000 white blood cells [WBCs]/μL), human immunodeficiency virus infection, or a history of crystal-induced arthropathy. Those without any of these conditions were classified as low risk.
The following information was collected from chart review: age; gender; number of days from the onset of arthritis; presence of fever; documentation of disseminated gonococcal disease; presence of a prosthesis in the involved joint, rheumatoid arthritis, osteoarthritis, diabetes mellitus, active malignancy, chemotherapy or immunosuppressant therapy, peripheral leukopenia, human immunodeficiency virus infection, and history of crystal-induced arthropathy; administration of antibiotics prior to arthrocentesis; synovial fluid analysis results; synovial fluid culture results; time to positivity of synovial fluid culture; and blood culture results. The results of subsequent synovial fluid cultures from the same admission were excluded. No personal identifying data were included.
The Albert Einstein Medical Center used a combination of standard plate culture and broth culture. This method has reported sensitivity between 75% and 95% and specificity of greater than 90%. Positive culture detection was done manually.
Demographic data of the sample were summarized using descriptive statistics. The positivity rate and time to positivity of synovial fluid cultures of all patients, high-risk patients, and low-risk patients were calculated and compared using χ test.
Materials and Methods
Study Design
We performed a retrospective cohort study designed to determine the positivity rate and time to positivity of synovial fluid cultures from adult inpatients with suspected acute bacterial arthritis.
Subjects
The records of all patients 18 years or older who were admitted in Albert Einstein Medical Center from December 10, 2010, to September 18, 2013, for joint complaints and had a synovial fluid culture were screened for the study. Cases of patients with acute (onset within the previous 2 weeks) monoarthritis with a synovial fluid specimen sent for Gram stain and culture were classified as suspected acute bacterial arthritis. Patients with disseminated gonococcal disease were excluded. Subjects were then classified as high risk or low risk for acute bacterial arthritis. High-risk patients had any 1 of the following: age at least 80 years old, rheumatoid arthritis, osteoarthritis, diabetes mellitus, active malignancy, chemotherapy or immunosuppressant therapy, joint prosthesis in the affected joint, peripheral leukopenia (<4000 white blood cells [WBCs]/μL), human immunodeficiency virus infection, or a history of crystal-induced arthropathy. Those without any of these conditions were classified as low risk.
Data Collection
The following information was collected from chart review: age; gender; number of days from the onset of arthritis; presence of fever; documentation of disseminated gonococcal disease; presence of a prosthesis in the involved joint, rheumatoid arthritis, osteoarthritis, diabetes mellitus, active malignancy, chemotherapy or immunosuppressant therapy, peripheral leukopenia, human immunodeficiency virus infection, and history of crystal-induced arthropathy; administration of antibiotics prior to arthrocentesis; synovial fluid analysis results; synovial fluid culture results; time to positivity of synovial fluid culture; and blood culture results. The results of subsequent synovial fluid cultures from the same admission were excluded. No personal identifying data were included.
Culture Method
The Albert Einstein Medical Center used a combination of standard plate culture and broth culture. This method has reported sensitivity between 75% and 95% and specificity of greater than 90%. Positive culture detection was done manually.
Data Analysis
Demographic data of the sample were summarized using descriptive statistics. The positivity rate and time to positivity of synovial fluid cultures of all patients, high-risk patients, and low-risk patients were calculated and compared using χ test.
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