Gram stain of joint fluid

Alternative names 
Joint fluid Gram stain

Joint fluid Gram stain tests for microorganisms (bacteria) using a special series of stains. In this test, a specimen of joint fluid is stained and examined under the microscope. The Gram stain method can be applied to almost any clinical specimen and is one of the most commonly used techniques for the rapid diagnosis of bacterial infections.

How the test is performed

The skin around the joint is cleaned, a needle is inserted into the joint, and fluid is aspirated (drawn out).

A drop of the joint fluid is then applied in a very thin layer to a microscope slide - this is called a smear. A series of stains called a Gram stain is applied to the specimen. It is first stained with crystal violet stain, then iodine, then decolorized, then stained with safranin.

The stained smear is then examined under the microscope for the presence of bacteria. The color, size, and morphologic appearance (shape) of the cells help identify the infecting organism.

How to prepare for the test
This test may be performed in the health care provider’s office.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
The joint is cleansed with an anti-bacterial soap. An anesthetic may be injected into the joint, and a stinging sensation may be felt. A needle is then inserted into the joint, and a small amount of fluid is withdrawn into a syringe. Pressure and pain in the joint may be present.

Why the test is performed
The test is performed for unexplained swelling, joint pain, and inflammation of a joint or suspected joint infection.

Normal Values
No organisms are present.

What abnormal results mean
Abnormal results - bacteria on the Gram stain - may indicate infection of the joint (for example, gonococcal arthritis). The type of bacteria seen can guide the doctor’s choice of antibiotics.

What the risks are
There is a small risk of infection or bleeding.

Special considerations
Other tests may be performed on the joint fluid.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.