Rapid and Accurate Diagnosis of Joint Infections: Potential Clinical Effect of
the BioFire Joint Infection Panel
#MMPMID41210903
Jeong HS
; Choi SM
; Kwon YJ
; Jang MO
; Kim MJ
; Kim S
; Lee A
; Kim SE
; Shin SU
; Kim UJ
; Kang SJ
; Jung SI
; Shin JH
; Won EJ
; Kim MN
; Park KH
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41210903
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BACKGROUND: Septic arthritis remains difficult to diagnose due to the low
sensitivity of culture-based methods, particularly after antibiotic exposure or
in the presence of fastidious organisms. The BioFire Joint Infection (JI) Panel
is a multiplex polymerase chain reaction assay that detects 31 pathogens and 8
resistance genes, offering improved diagnostic performance. METHODS: Synovial
fluid samples from 154 patients at 4 tertiary hospitals in Korea (November
2022-August 2024) were retrospectively analyzed using the JI panel. Results were
compared with synovial fluid culture for pathogen detection, diagnostic
sensitivity, and potential impact on antimicrobial decision making, assuming
panel results had been available at the time of treatment. RESULTS: Among 154
patients, 67 had JIs (16 native and 51 prosthetic), and 32 were
culture-confirmed. The JI panel identified pathogens in 43.8% of native and 37.3%
of prosthetic JIs. For on-panel organisms, it showed 96.2% sensitivity and 100%
specificity, improving detection by 34.6%. It also detected 9 pathogens missed by
culture and could have reduced the time of identification by ?73 hours.
Antibiotic adjustments would have been potentially applicable in over 70% of JI
panel-positive cases. De-escalation or discontinuation of broad-spectrum
antibiotics could have reduced exposure by more than 80 hours. Escalation or
initiation of targeted therapy could have occurred in 27% of the cases, enabling
treatment 70 hours earlier than actual antibiotic modification, particularly in
Gram-negative infections. CONCLUSION: The JI panel showed high concordance with
culture-positive cases and identified additional pathogens in culture-negative
samples. Its rapid turnaround time and improved detection support antimicrobial
stewardship by enabling earlier, targeted therapy. However, its utility is
limited by fixed coverage and exclusion of off-panel pathogens. LEVEL OF
EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete
description of levels of evidence.
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