BioFire in osteoarticular Infections: Rapid syndromic testing for early and accurate diagnosis - A narrative review

In the increasing peril due to multidrug-resistant (MDR) pathogens, importance of novel molecular technologies for rapid pathogen identification has been acknowledged. In this context, the role of multiplex molecular technique, BioFire® Arthritis panel (BFAP) in the evaluation of osteoarticular infections (OI) has been recognized. The current review was performed to comprehensively evaluate the status of BFAP in OI.

A literature search was performed in June 2024 using five databases. Clinical studies (prospective and retrospective series) evaluating the role of BFAP in OI were considered. Experimental studies, editorials, and reviews were excluded. A narrative approach was used for the synthesis of results.

Ten manuscripts were finally selected for the review. This test uses cartridge methodology, and the panel includes 31 microorganisms and eight resistance markers. The panel consists of nucleic acid extraction, reverse transcription, amplification of nucleic acid, and analysis of results in an automated manner (approximated duration of 1 h/run). It has been acknowledged for providing rapid results with relatively good diagnostic precision (90.9 % sensitivity, 98.5 % specificity). However, when off-panel pathogens (like Staphylococcus epidermidis/Cutibacterium acnes) are considered, sensitivity drops to 56 %. It significantly impacts its accuracy and false negative results.

The benefits of the BioFire® panel include rapid turn-around time, excellent sensitivity and specificity for on-panel pathogens, and ability to identify antimicrobial resistance. The benefits of BFAP are demonstrated in native septic arthritis and OI in pediatric population. In view of exclusion of specific organisms, its sensitivity and accuracy in diagnosing PJI (early acute PJI) and chronic infections are low.