High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee
ABSTRACT The BioFire Joint Infection (JI) Panel is a multiplex polymerase chain reaction assay developed for rapid pathogen detection in synovial fluid, particularly for suspected prosthetic joint infections (PJI). However, its diagnostic sensitivity varies by clinical context and pathogen, and the...
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American Society for Microbiology
2025-08-01
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| Series: | Microbiology Spectrum |
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| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.00286-25 |
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| author | Tsung-Li Lin Chen-Wei Yeh Chun-Hao Tsai Mao-Wang Ho Hsiu-Hsien Lin Po-Ren Hsueh |
| author_facet | Tsung-Li Lin Chen-Wei Yeh Chun-Hao Tsai Mao-Wang Ho Hsiu-Hsien Lin Po-Ren Hsueh |
| author_sort | Tsung-Li Lin |
| collection | DOAJ |
| description | ABSTRACT The BioFire Joint Infection (JI) Panel is a multiplex polymerase chain reaction assay developed for rapid pathogen detection in synovial fluid, particularly for suspected prosthetic joint infections (PJI). However, its diagnostic sensitivity varies by clinical context and pathogen, and the impact of prior antibiotic exposure on sample quality and PJI stewardship remains unclear. This prospective study evaluated the diagnostic performance of the Investigational Use Only JI Panel versus conventional synovial fluid culture, using Musculoskeletal Infection Society criteria and symptom onset within 3 weeks to define acute PJI. Fifty-four fresh synovial fluid samples from patients with suspected knee PJI were analyzed. In acute PJI, the JI Panel demonstrated comparable sensitivity to synovial fluid culture (80% vs. 95%; P = 0.096), while significantly reducing time to pathogen identification (mean 18.2 vs. 84.6 hours, P < 0.001), enabling earlier targeted antibiotic therapy in 83.3% of cases. Overall sensitivity across all PJI cases was moderate (50%) and significantly lower in chronic PJI (16.7%), reflecting limited panel coverage and reduced detection in prolonged infections. Prior antibiotic exposure reduced sensitivity for both methods, though not significant (P = 0.127). The absence of key pathogens such as Staphylococcus epidermidis and Cutibacterium acnes further limited diagnostic yield in chronic cases. The JI Panel offers a rapid and clinically impactful tool for diagnosing acute PJI and guiding antibiotic stewardship. However, its limitations in chronic PJI and susceptibility to antibiotic pretreatment restrict its standalone diagnostic utility. Therefore, it should complement, not replace, traditional culture methods, particularly in chronic PJI cases.IMPORTANCEThe JI Panel demonstrates high sensitivity for acute PJI but lower sensitivity for chronic infections. The ability of the JI Panel to rapidly identify pathogens in acute cases plays a significant role in improving antibiotic stewardship, ensuring timely and appropriate treatment. Given the lower sensitivity for chronic PJI, further research could focus on improving the detection of pathogens that are commonly involved in chronic infections. While the JI Panel is a promising tool for acute PJI diagnosis and supports rapid antibiotic stewardship, its limitations in chronic cases and under antibiotic exposure must be addressed to maximize its clinical utility. |
| format | Article |
| id | doaj-art-58fad0be91dc46dcb05a6dd262b10ebb |
| institution | Kabale University |
| issn | 2165-0497 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | American Society for Microbiology |
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| series | Microbiology Spectrum |
| spelling | doaj-art-58fad0be91dc46dcb05a6dd262b10ebb2025-08-20T04:00:45ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972025-08-0113810.1128/spectrum.00286-25High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the kneeTsung-Li Lin0Chen-Wei Yeh1Chun-Hao Tsai2Mao-Wang Ho3Hsiu-Hsien Lin4Po-Ren Hsueh5Department of Orthopedics, China Medical University Hospital, Taichung, TaiwanDepartment of Orthopedics, China Medical University Hospital, Taichung, TaiwanDepartment of Orthopedics, China Medical University Hospital, Taichung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, TaiwanDepartment of Laboratory Medicine, China Medical University Hospital, China Medical University, Taichung, TaiwanDivision of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, TaiwanABSTRACT The BioFire Joint Infection (JI) Panel is a multiplex polymerase chain reaction assay developed for rapid pathogen detection in synovial fluid, particularly for suspected prosthetic joint infections (PJI). However, its diagnostic sensitivity varies by clinical context and pathogen, and the impact of prior antibiotic exposure on sample quality and PJI stewardship remains unclear. This prospective study evaluated the diagnostic performance of the Investigational Use Only JI Panel versus conventional synovial fluid culture, using Musculoskeletal Infection Society criteria and symptom onset within 3 weeks to define acute PJI. Fifty-four fresh synovial fluid samples from patients with suspected knee PJI were analyzed. In acute PJI, the JI Panel demonstrated comparable sensitivity to synovial fluid culture (80% vs. 95%; P = 0.096), while significantly reducing time to pathogen identification (mean 18.2 vs. 84.6 hours, P < 0.001), enabling earlier targeted antibiotic therapy in 83.3% of cases. Overall sensitivity across all PJI cases was moderate (50%) and significantly lower in chronic PJI (16.7%), reflecting limited panel coverage and reduced detection in prolonged infections. Prior antibiotic exposure reduced sensitivity for both methods, though not significant (P = 0.127). The absence of key pathogens such as Staphylococcus epidermidis and Cutibacterium acnes further limited diagnostic yield in chronic cases. The JI Panel offers a rapid and clinically impactful tool for diagnosing acute PJI and guiding antibiotic stewardship. However, its limitations in chronic PJI and susceptibility to antibiotic pretreatment restrict its standalone diagnostic utility. Therefore, it should complement, not replace, traditional culture methods, particularly in chronic PJI cases.IMPORTANCEThe JI Panel demonstrates high sensitivity for acute PJI but lower sensitivity for chronic infections. The ability of the JI Panel to rapidly identify pathogens in acute cases plays a significant role in improving antibiotic stewardship, ensuring timely and appropriate treatment. Given the lower sensitivity for chronic PJI, further research could focus on improving the detection of pathogens that are commonly involved in chronic infections. While the JI Panel is a promising tool for acute PJI diagnosis and supports rapid antibiotic stewardship, its limitations in chronic cases and under antibiotic exposure must be addressed to maximize its clinical utility.https://journals.asm.org/doi/10.1128/spectrum.00286-25Joint Infection Panelprosthetic joint infectionsynovial fluid cultureantibiotic exposureantibiotic stewardship |
| spellingShingle | Tsung-Li Lin Chen-Wei Yeh Chun-Hao Tsai Mao-Wang Ho Hsiu-Hsien Lin Po-Ren Hsueh High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee Microbiology Spectrum Joint Infection Panel prosthetic joint infection synovial fluid culture antibiotic exposure antibiotic stewardship |
| title | High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee |
| title_full | High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee |
| title_fullStr | High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee |
| title_full_unstemmed | High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee |
| title_short | High sensitivity and enhanced antibiotic stewardship of the BioFire Joint Infection Panel in acute, but not chronic, prosthetic joint infection of the knee |
| title_sort | high sensitivity and enhanced antibiotic stewardship of the biofire joint infection panel in acute but not chronic prosthetic joint infection of the knee |
| topic | Joint Infection Panel prosthetic joint infection synovial fluid culture antibiotic exposure antibiotic stewardship |
| url | https://journals.asm.org/doi/10.1128/spectrum.00286-25 |
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