A multicentre evaluation and expert recommendations of use of the newly developed BioFire Joint Infection polymerase chain reaction panel

Abstract

Septic arthritis is a serious condition with significant morbidity and mortality, routinely diagnosed using culture. The FDA has recently approved the rapid molecular BioFire® Joint Infection Panel (BJIP) for synovial fluid. We aimed to evaluate the BJIP compared to culture and its potential use in patient management. A multicentre retrospective evaluation of BJIP was conducted in the UK and Ireland. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated between the BJIP and routine culture. A multidisciplinary team (MDT) discussion addressing the optimal or potential case use of the assay practice was facilitated. Three hundred ninety-nine surplus synovial fluid samples (~ 70% from native joints) from eight centres were processed using BJIP in addition to routine culture. An increased yield of positive results was detected using BJIP compared to routine culture (98 vs 83), giving an overall PPA of 91.6% and overall NPA of 93% for the BJIP compared to culture results. The BJIP detected resistant markers and additional organisms that could influence antibiotic choices including Neisseria gonorrhoeae and Kingella kingae. The MDT agreed that the assay could be used, in addition to standard methods, in adult and children patients with specialist advice use based on local needs. Rapid results from BJIP were assessed as having potential clinical impact on patient management. Organisms not included in the panel may be clinically significant and may limit the value of this test for PJI.

Atypical Staphylococcal Septic Arthritis in a Native Hip: A Case Report and Review

“…They found that BioFire mPCR had an overall sensitivity of 91.6% and specificity of 93%. More specific to S. aureus , BioFire mPCR correctly identified 41 samples of S. aureus whereas routine culture correctly identified 37 samples [ 33 ]. Shoenmakers et al evaluated the performance of BioFire mPCR in 45 synovial fluid samples from patients who had clinical suspicion of septic arthritis, demonstrating a sensitivity of 83% and specificity of 100% in native septic arthritis.…”

Exclusively Oral Treatment for Osteoarticular Infections in Children. Is It Time?

“…More recently, a specific panel for the microbiological diagnosis of OAI in the synovial fluid, the BIOFIRE® JI panel, was introduced in the market and there are already few studies showing its utility. For instance, in a multicentre retrospective evaluation of the BIOFIRE® JI panel, testing 399 synovial fluids from adults mostly and a few from children with acute OAI there was an increased diagnostic yield of the panel compared to routine culture [18]. Although they had only few cases of K. kingae and N. gonorrhoae, they mentioned that the ability to detect additional organisms might influence antibiotic choices.…”

Will Preoperative Synovial Fluid Antigen Testing Change Our Clinical Practice?

“…Because the antibiotic treatments for methicillin-sensitive staphylococci compared with methicillin-resistant staphylococci and for Enterococcus faecalis compared with Enterococcus faecium are different, their identification on a genus level cannot fully target antibiotic treatment. Other tests that overcome this limitation are available, such as the recently launched multiplex polymerase chain reaction (PCR) for bone and joint infections 1 . The BioFire Joint Infection PCR Panel provides a rapid diagnosis (i.e., within 1 hour), includes more genera and identifies pathogens on a species level, and detects resistance genes, which may better guide antimicrobial treatment 1 .…”

“…Other tests that overcome this limitation are available, such as the recently launched multiplex polymerase chain reaction (PCR) for bone and joint infections 1 . The BioFire Joint Infection PCR Panel provides a rapid diagnosis (i.e., within 1 hour), includes more genera and identifies pathogens on a species level, and detects resistance genes, which may better guide antimicrobial treatment 1 . Also, other microorganisms not detected by the PCR test may be involved.…”

“…Marjan Wouthuyzen-Bakker, MD, PhD 1 1 Infectious Disease Specialist, Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands Email: m.wouthuyzen-bakker@umcg.nl Disclosure: The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJS/H395).…”