Is gram stain accurate for a diagnosis of septic joints?

Gram stain has long been the standard in deciding to treat a patient with a suspected septic joint. Orthopedics will refrain from treating suspected septic joints if the gram stain is negative and will await the fluid culture analysis which may take 48-72 hours to be resulted. This delays the care of the patient in treatment of their septic joint. Ideally, patients are treated early to prevent long term damage and disability from the septic joint infection. Due to the high false negative rate of gram stains, it is recommended that emergency medicine providers begin initial treatment with antibiotics while awaiting the fluid culture analysis for suspected septic joints