The role of BioFire Joint Infection Panel in diagnosing periprosthetic hip and knee joint infections in patients with unclear conventional microbiological results

This study aimed to evaluate the BioFire Joint Infection (JI) Panel in cases of hip and knee periprosthetic joint infection (PJI) where conventional microbiology is unclear, and to assess its role as a complementary intraoperative diagnostic tool. Five groups representing common microbiological scen...

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Bibliographic Details
Published in:	Bone & joint research Vol. 13; no. 7; pp. 353 - 361
Main Authors:	Gardete-Hartmann, Susana, Mitterer, Jennyfer A, Sebastian, Sujeesh, Frank, Bernhard J H, Simon, Sebastian, Huber, Stephanie, Löw, Marcellino, Sommer, Ian, Prinz, Morjan, Halabi, Milo, Hofstaetter, Jochen G
Format:	Journal Article
Language:	English
Published:	England The British Editorial Society of Bone & Joint Surgery 10-07-2024
Subjects:	arthroplasty registry hip Infection infections joint infection panel joint infections microorganism(s) periprosthetic joint infection (pji) prosthetic joint infection revision hip and knee arthroplasty synovial fluid total hip and knee arthroplasty total hip or knee arthroplasty unclear microbiological results
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Summary:	This study aimed to evaluate the BioFire Joint Infection (JI) Panel in cases of hip and knee periprosthetic joint infection (PJI) where conventional microbiology is unclear, and to assess its role as a complementary intraoperative diagnostic tool. Five groups representing common microbiological scenarios in hip and knee revision arthroplasty were selected from our arthroplasty registry, prospectively maintained PJI databases, and biobank: 1) unexpected-negative cultures (UNCs), 2) unexpected-positive cultures (UPCs), 3) single-positive intraoperative cultures (SPCs), and 4) clearly septic and 5) aseptic cases. In total, 268 archived synovial fluid samples from 195 patients who underwent acute/chronic revision total hip or knee arthroplasty were included. Cases were classified according to the International Consensus Meeting 2018 criteria. JI panel evaluation of synovial fluid was performed, and the results were compared with cultures. The JI panel detected microorganisms in 7/48 (14.5%) and 15/67 (22.4%) cases related to UNCs and SPCs, respectively, but not in cases of UPCs. The correlation between JI panel detection and infection classification criteria for early/late acute and chronic PJI was 46.6%, 73%, and 40%, respectively. Overall, the JI panel identified 12.6% additional microorganisms and three new species. The JI panel pathogen identification showed a sensitivity and specificity of 41.4% (95% confidence interval (CI) 33.7 to 49.5) and 91.1% (95% CI 84.7 to 94.9), respectively. In total, 19/195 (9.7%) could have been managed differently and more accurately upon JI panel evaluation. Despite its microbial limitation, JI panel demonstrated clinical usefulness by complementing the traditional methods based on multiple cultures, particularly in PJI with unclear microbiological results.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 S. Gardete Hartmann reports financial support from BioFire Diagnostics, bioMérieux for attendance with oral presentation and poster presentation at 40th Annual Meeting of the European Bone and Joint Infection Society (EBJIS), and the Interdisciplinary Course on Antibiotics and Resistance (ICARe) 2022, respectively. J. G. Hofstaetter and S. Gardete Hartmann report payment for expert testimonial by BioFire Diagnostics, bioMérieux, unrelated to this study. The remaining co-authors report no conflict of interest.
ISSN:	2046-3758 2046-3758
DOI:	10.1302/2046-3758.137.BJR-2023-0321.R2