Joint fluid Gram stain is a laboratory test to identify bacteria in a sample of joint fluid using a special series of stains (colors). The Gram stain method is one of the most commonly used methods to rapidly diagnose bacterial infections.

Gram stain of joint fluid

A sample of joint fluid is needed. For information on how this procedure is done, see joint fluid aspiration.

The fluid sample is sent to a lab where a small drop is placed in a very thin layer onto a microscope slide. This is called a smear. Several different colored stains are applied to the sample. The laboratory personnel will look at the stained smear under a microscope to see if bacteria are present. The color, size, and shape of the cells help identify the bacteria.

For information on how to prepare for the removal of joint fluid, see joint fluid aspiration.

For information on how it will feel when the joint fluid is removed, see joint fluid aspiration.

The test is performed when there is unexplained swelling, joint pain, and inflammation of a joint, or to check for suspected joint infection.

A normal result means no bacteria are present on the Gram stain.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Abnormal results mean bacteria were seen on the Gram stain. This may be a sign of a joint infection, for example, gonococcal arthritis or arthritis due to Staphylococcus aureus.

There is no risk to the patient associated with a Gram stain. For information regarding risks related to the removal of joint fluid, see joint fluid aspiration.

Matteson EL, Osmon DR. Infections of bursae, joints, and bones. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 280.

Ohl CA. Infectious arthritis of native joints. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009:chap 102.