Automated multiplex PCR of BioFire joint infection panel enables rapid pathogen identification in periprosthetic joint infection excluding coagulase-negative Staphylococci.

Abstract

Periprosthetic joint infection (PJI) is a serious complication requiring rapid diagnosis for effective treatment. The BIOFIRE® Joint Infection (JI) Panel, a fully automated multiplex PCR system, enables the identification of 31 organisms and 8 antimicrobial resistance (AMR) genes within 1 h, offering a promising diagnostic method. However, its diagnostic performance, particularly in Asian populations, remains underexplored. This retrospective study analyzed 60 cases of suspected PJI between 2022 and 2023. Synovial fluid samples were evaluated using the JI Panel and microbiological culture, with PJI diagnoses based on the International Consensus Meeting 2018 criteria. Diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed by comparing JI Panel results with microbiological culture findings or PJI diagnosis. Among 60 cases, 33 were diagnosed with PJI. The JI Panel demonstrated a sensitivity of 45.5 % and a specificity of 100 % for detecting PJI, while microbiological culture showed a sensitivity of 63.6 % and specificity of 100 %. Combined use of the JI Panel and culture improved diagnostic sensitivity to 69.7 %. Notably, the JI Panel identified pathogens in two culture-negative PJI cases. Limitations of the JI Panel included its inability to detect coagulase-negative staphylococci (CNS), such as Staphylococcus epidermidis. However, the JI Panel successfully identified Candida species, a pathogen often undetected by conventional methods. The JI Panel facilitates rapid and accurate diagnosis of PJI with high specificity. Although limited by its low sensitivity for CNS-associated infections, the ability to rapidly identify causative organisms and detect fungal pathogens supports its clinical utility. Implementation of the JI Panel in diagnostic laboratories may expedite diagnosis, reduce unnecessary antibiotic use, and alleviate the burden of multidrug-resistant infections. The BIOFIRE® JI Panel offers a highly specific, fully automated method for the rapid diagnosis of PJI. Its adoption in clinical practice may enhance diagnostic accuracy, particularly for culture-negative cases, although improvements in detecting CNS pathogens are necessary.