Rapid and Accurate Diagnosis of Joint Infections: Potential Clinical Effect of the BioFire Joint Infection Panel

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.

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.

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.

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.

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.