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Updated: Oct 17, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Evaluation of the BioFire joint infection panel in Taiwan: Impact of regional non-target pathogens and joint type on
Shih-Hao Lo1, Chieh Chin2, Hsuan-Ti Huang3
1Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan.
Objectives:
The BIOFIRE® Joint Infection (BJI) panel, a rapid multiplex polymerase chain reaction assay, is used to diagnose joint infections. Here we used it to evaluate the clinical performance and impact of antimicrobial resistance (AMR) detection in Taiwan's unique microbial landscape.
Methods:
Adult patients with suspected septic arthritis or prosthetic joint infection were prospectively enrolled from four hospitals in southern Taiwan. Synovial fluid specimens were tested using a BJI panel and routine bacterial culturing. Performance was assessed by calculating the positive percent agreement and negative percent agreement (PPA and NPA, respectively).
Results:
Eighty-six specimens (native joints, 56; prosthetic joints, 30) were analyzed. The overall PPA and NPA were 92.3% and 76.7%, respectively. Native joints showed higher concordance (PPA, 93.8%; NPA, 85.0%) than prosthetic joints (PPA, 90.0%; NPA, 60.0%). The BJI panel detected pathogens in 14 culture-negative cases, predominantly among patients who previously received antibiotics. Notably, the panel identified six methicillin-resistant Staphylococcus aureus cases (three culture-negative) and one blaCTX-M-positive E. coli detection. However, three culture-positive cases involving "off-panel" regional pathogens (Burkholderia pseudomallei, n = 2; Mycobacterium tuberculosis complex, n = 1) were BJI-negative. Diagnostic concordance is better in native joints and correlated significantly with higher synovial leukocyte counts.
Conclusions:
Our evaluation revealed the BJI panel's ability to rapidly identify pathogens and profile AMR, with additional diagnostic yield particularly in culture-negative prosthetic joint infections and in patients with prior antibiotic exposure. However, its limited detection targets leave a diagnostic gap for regionally endemic pathogens such as Burkholderia pseudomallei and Mycobacterium tuberculosis complex, indicating the continued need for conventional culturing.
