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Updated: May 12, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Automated multiplex PCR of BioFire joint infection panel enables rapid pathogen identification in periprosthetic
Hyonmin Choe1, Naomi Kobayashi2, Yuta Hieda1
1Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa Japan.
Introduction:
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.
Methods:
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.
Results:
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.
Discussion:
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.
Conclusion:
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.
Insights
The BIOFIRE® Joint Infection (JI) Panel offers rapid and specific diagnosis for periprosthetic joint infection (PJI). While it has limitations in detecting certain bacteria, its speed and ability to identify fungal pathogens aid clinical decisions.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a severe complication demanding swift diagnosis for effective treatment.
- The BIOFIRE® Joint Infection (JI) Panel is a rapid, automated multiplex PCR system identifying 31 organisms and 8 antimicrobial resistance (AMR) genes.
- Its diagnostic performance in Asian populations requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic performance of the BIOFIRE® JI Panel for periprosthetic joint infection (PJI).
- To compare the JI Panel with traditional microbiological culture methods.
- To assess the utility of the JI Panel in a clinical setting, particularly in Asian populations.
Main Methods:
- Retrospective analysis of 60 suspected PJI cases (2022-2023).
- Evaluation of synovial fluid samples using the JI Panel and microbiological culture.
- Diagnosis of PJI based on International Consensus Meeting 2018 criteria.
- Assessment of diagnostic accuracy metrics: sensitivity, specificity, PPV, and NPV.
Main Results:
- The JI Panel showed 45.5% sensitivity and 100% specificity for PJI detection.
- Microbiological culture yielded 63.6% sensitivity and 100% specificity.
- Combined JI Panel and culture improved sensitivity to 69.7%.
- The JI Panel detected pathogens in two culture-negative PJI cases and identified Candida species.
- Limitations included inability to detect coagulase-negative staphylococci (CNS).
Conclusions:
- The JI Panel provides rapid and highly specific diagnosis for PJI.
- Its ability to detect fungal pathogens and aid culture-negative cases is clinically valuable.
- Further improvements are needed for detecting CNS pathogens for comprehensive PJI diagnostics.
