Synovial fluid lactate and the diagnosis of septic arthritis (original) (raw)
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Skeletal Radiology, 2008
Objective The aim of this study was to differentiate septic from non-septic arthritis by measuring lactate concentration with 1 H magnetic resonance spectroscopy (HMRS) and by estimating total protein content with the assessment of T 2 values. Materials and methods In 30 patients with acute arthritis, synovial fluid was aspirated. Lactate concentrations were analyzed with single voxel HMRS at 1.5 T. T 2 relaxation times were mapped with a multi-spin echo sequence. All samples underwent microbiological testing and routine laboratory analysis to quantify lactate concentration and total protein content. Values obtained in septic and nonseptic arthritis were compared with a Mann-Whitney U test. Results Synovial fluid from patients with septic arthritis (n= 10) had higher concentrations of lactate (11.4±4.0 mmol/L) and higher total protein content (51.8±10.7 g/L) than fluid obtained in non-septic arthritis (n=20; 5.2±1.1 mmol/L and 40.4±6.9 g/L, respectively, p<0.001 and <0.01, respectively). Measured lactate concentrations and T 2 relaxation times (as an indicator of total protein content) were moderately correlated to laboratory-confirmed lactate concentration (r 2 = 0.71) and total protein content (r 2 =0.73). Markedly increased lactate concentrations (>6 mmol/L) in combination with low T 2 values (<550 ms) identify septic arthritis with a sensitivity of 70% and a specificity of 89%.
Utility of point-of-care synovial lactate to identify septic arthritis in the emergency department
American Journal of Emergency Medicine, 2019
Background: Synovial lactate is a promising biomarker to distinguish septic from aseptic arthritis. If available as a point-of care test, synovial lactate would be rapidly available to aid the emergency provider in clinical decision making. This study assesses the test characteristics of synovial lactate obtained using an EPOC© point-of-care (POC) analyzer to rapidly distinguish septic from aseptic arthritis in the emergency department. Methods: We enrolled a convenience sample of patients with possible septic arthritis presenting to the emergency department at a large urban academic center between October 2016 and April 2018. Enrolled patients underwent arthrocentesis based on the clinical judgment of the treating provider. We obtained synovial lactate levels (SLL) from the POC device. Standard laboratory analysis, synovial fluid culture, emergency and hospital course, operative procedures, antibiotics, and discharge diagnosis were abstracted from the electronic medical record. Results: Thirty-nine patients undergoing forty separate arthrocentesis procedures were enrolled in this study over the two-year period. The sensitivity and specificity of SLL ≥ 5 mmol/L was 0.55 and 0.76 respectively, with +LR 2.3 and −LR 0.6. The sensitivity and specificity of SLL ≥ 10 mmol/L was 0.27 and 0.97 respectively, with +LR 7.9 and −LR 0.8; SLL ≥ 10 mmol/L performed similarly to overall synovial WBC ≥ 50,000/μL by conventional laboratory testing. Conclusion: It is feasible to obtain a synovial lactate level using the EPOC© POC device. In our study, POC SLL performs similarly to other markers used to diagnose septic arthritis. Further study with larger sample sizes is warranted.
Evaluation of synovial fluid culture in patients with high suspicion for septic arthritis
2012
Septic arthritis is the infection of joints and delay in treatment may lead to irrecoverable injuries such as joint destruction and dissemination of infection to other organs. The aims of this study were to evaluate synovial fluid cultures in patients with high suspicion for septic arthritis, their clinical and laboratory findings and to determine probable causes of true/false negative cultures. In this cross-sectional study, 25 patients with painful and swollen joint and high clinical suspicion for septic arthritis enrolled the study. Sterile synovial fluid aspiration was performed and specimens were evaluated direct smear for gram staining and 3 different cultures using chocolate agar, Mac-Conkey and blood agar for 24 hours. Blood samples were also obtained for culture. Data were analyzed using SPSS software (version 15). Fever, joint pain, swelling, warmth and tenderness were reported by all patients. Ten patients (40%) suffered from chilling and 24 patients (96%) from restricted...
Synovial Fluid Lactate for the Diagnosis of Joint Infection:A Systematic Review
2020
Many host-specific synovial fluid biomarkers were investigated for the diagnosis of joint infections; including lactate, adenosine deaminase, calprotectin, alfa-defensin, alpha-2-macroglobulin, C-reactive protein (CRP), leukocyte esterase, and interleukin-6 (IL-6). Therefore, we aimed to systematically review the current evidence discussing the usage of synovial fluid lactate as a biomarker in the diagnosis of joint infection. The search was conducted through seven databases with the usage of the search, followed by searching the references of included papers to avoid missing relevant included papers. We included papers reporting the use of D-lactate in synovial fluid for the diagnosis of joint infections. Finally, 13 papers, with 2243 recruited patients, were included in the study. In general, the synovial lactate showed a good diagnostic value with an area under the receiver operating characteristic curve (AUC) ranging from 76% [23] to 95% [8]. The sensitivity of diagnosing joint infection ranged from 73.3% [23] to 95.7% [8], while specificity ranged from 66.7% to 96%. In conclusion, the synovial fluid lactate can be used as a screening biomarker for septic arthritis, with having the advantages of being inexpensive, needs a small volume of synovial fluid, and short turnaround time. Several risk factors were reported to induce joint infection. Berbari., et al. indicated that rheumatoid arthritis, steroid therapy, malignancy in general, joint malignancy, diabetes mellitus, and previous arthroplasty are potential risk factors for joint infection [3]. Bacterial
Rheumatology Advances in Practice
Objective Diagnosing septic arthritis can be challenging and frequently involves clinical assessment, laboratory investigations and synovial fluid analysis. We sought to determine the utility of synovial aspiration and intra-operative synovial fluid and tissue culture for the accurate diagnosis of septic arthritis. Methods We carried out a retrospective review of the records of patients referred to a tertiary orthopaedic unit with possible septic arthritis between 2015 and 2019 inclusive, including clinical and laboratory data for this cohort study. Performance characteristics were determined for synovial aspiration, intra-operative synovial fluid and tissue culture in diagnosing expert review-determined true septic arthritis. Concordance between discharge diagnosis, antibiotic prescribing and true septic arthritis was determined. Results Of 268 patients identified with suspected septic arthritis, 143 underwent both synovial fluid aspiration and intra-operative synovial fluid and ti...
CJEM, 2015
To determine the sensitivity and specificity of clinical and laboratory signs for the diagnosis of septic arthritis (SA). Patients and methods This prospective study included all adult patients with suspected SA seen in the emergency department or rheumatology department at the University Hospital, Clermont-Ferrand, France, over a period of 18 months. In total, 105 patients with suspected SA were included, 38 (36%) presenting with SA (29 [28%] with bacteriologically documented SA). In the univariate analysis, chills (p=0.015), gradual onset (p=0.04), local redness (p=0.01), as well as an entry site for infection (p=0.01) were most often identified in SA. A history of crystal-induced arthritis (p=0.004) was more frequent in non-SA cases. An erythrocyte sedimentation rate (ESR)>50 mm (p=0.005), a C-reactive protein (CRP) level >100 mg/L (p=0.019), and radiological signs suggestive of SA (p=0.001) were more frequent in the SA cases. Synovial fluid appearance: purulent (p<0.001...
Open Journal of Orthopedics, 2015
Introduction & aims: Septic arthritis is an emergency, potentially causing irreversible joint destruction and disability. Synovial WCC and polymorphonuclear cell percentage are the best predictors of septic arthritis likelihood. Yet, synovial white cell and differential count are not routinely assessed. We aim to investigate the incidence of failure to perform these tests, and to develop correct synovial fluid analysis practices. Method: This is a retrospective analysis of native joints having undergone arthrocentesis for suspicion of septic arthritis at Box Hill Hospital (BHH) during September 2011 and September 2013 inclusive. Recruitment was from the Eastern Health Decision Support Service (DSS), a database compiled from all systems within Eastern Health, of which BHH is a member. The study was limited to large joints, including hip, knee and shoulder. All prosthetic joints were excluded from the patient population. All patient histories were examined for suspicion of septic arthritis and subsequent arthrocentesis. Pathology records were accessed to determine incidence of cell count and differential. Results: One hundred and thirty-six cases of joint aspirations were identified within the time frame, of which sixty-seven fitted our criteria for evaluation. All but two cases were delivered using the DSS, which was limited to data compiled only until June 2013. The two remaining cases were identified with a manual search of the radiology and pathology databases from June to September 2013. 22 of the 67 joint aspirates studied did not have a cell count carried out. Four of these 22 cases had a diagnosis of septic arthritis. In five aspirates, there was a failure to confirm a definite diagnosis and they were thus conservatively treated as a septic joint. The remaining acute joints in which no cell count was done were gout (7 cases), pseudogout (5 cases) and rheumatoid arthritis (1 case). Cell counts were not routinely detected for a variety of reasons. Eleven aspirates were deemed too viscous, and in eight cases the sample had clotted prior to pathologist assessment. Two cases had insufficient volume, and one sample was too bloodstained to calculate a cell count and differential; likely due to traumatic aspiration. Conclusions: 33% of acute monoarthritis' evaluated over the study period failed to have a synovial fluid WCC and differential. This may be due to inadequate samples, or lack of K. Perera 401 appropriate collection tube. Better education is required for appropriate collection and test requesting wherein a diagnosis of septic arthritis is in question.
Effectiveness of leucocyte esterase as a diagnostic test for acute septic arthritis
Journal of Orthopaedic Surgery, 2017
Background: We hypothesized that leucocyte esterase strip test can aid in diagnosing septic arthritis in native synovial fluid because leucocyte esterase concentrations would be elevated at the infection site because of secretion by recruited neutrophils. Method: The cohort included 27 patients (suspected septic arthritis and normal subjects). A standard chemical test strip (graded as negative, trace, +, ++ or +++) was used to detect the presence of leucocyte esterase. Fluid leucocyte count, Gram staining, culture, erythrocyte sedimentation rate and C-reactive protein were also assessed. Results: The leucocyte esterase test with a threshold of ++/+++ had a sensitivity of 79.2% (95% CI [confidence interval], 65.9% to 89.2%), specificity of 80.8% (95% CI, 73.3% to 87.1%), positive predictive value (PPV) of 61.8% (95% CI, 49.2% to 73.3%) and negative predictive value (NPV) of 90.1% (95% CI, 84.3% to 95.4%). Conclusion: The leucocyte esterase strip test yielded a high specificity, PPV, ...
American family physician, 2011
Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. In the absence of peripheral leukopenia or prosthetic joint replacement, synovial fluid white blood cell count in patients with septic arthritis is usually greater than 50,000 per mm3. Isolation of the causative agent through synovial fluid culture is not only definitive but also essential before selecting antibiotic therapy. Synovial fluid analysis is also useful to help distinguish crystal arthropathy from infectious arthritis, although the two occasionally coexist. Almost any microorganism can be pathogenic in septic arthritis; however, septic arthritis is caused by nongonococcal pathogens (most commonly Staphylococcus species) in more than 80 percent of patients. G...