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. 2024 Jul 10;13(7):353-361.
doi: 10.1302/2046-3758.137.BJR-2023-0321.R2.

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

Susana Gardete-Hartmann  1 , Jennyfer A Mitterer  1 , Sujeesh Sebastian  1 , Bernhard J H Frank  1 , Sebastian Simon  1 , Stephanie Huber  1 , Marcellino Löw  1 , Ian Sommer  1 , Morjan Prinz  2 , Milo Halabi  3 , Jochen G Hofstaetter  1   4
Affiliations

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

Susana Gardete-Hartmann et al. Bone Joint Res. .

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Performance of the BioFire Joint Infection (JI) panel technology (bioMérieux) in periprosthetic hip and knee cases with unclear microbiological results. The number of positive JI panel results was compared with the number of positive (culture-positive) and negative (culture-negative) results initially obtained (at the time of the specific procedure) by conventional culture either on a) synovial fluid (SF) only or on b) tissue(s) and/or sonication fluid only from infected, non-infected, and inconclusive cases. c) Percentage of positive agreement between JI panel-positive results and PJI classification according to International Consensus Meeting (ICM) 2018 criteria, including early acute, late acute, and chronic infections. Cult.-neg., culture-negative; Cult.-pos., culture-positive; JI pos., JI-positive; Multi-pos., multi-positive; Single-pos., single-positive; UNC, unexpected negative-culture; UPC, unexpected positive-culture.
Fig. 2
Fig. 2
Comparison of results obtained using conventional microbiology methods and the BioFire Joint Infection (JI) panel technology when the comparison of the matched synovial fluid (SF) was made either a) to the SF culture result, or b) to the culture result(s) of tissue(s) and/or sonication fluid. Cases were classified as JI 'on-panel', 'off-panel', and culture-negative according to the initial culture results. JI positive, positive detection with the JI panel; match with conv. Microb. (concordant with conventional microbiology), concordant result between JI panel and culture methods; match with conv. + additional microorg. (concordant with conventional microbiology + additional microorganisms), concordant result between JI panel and microbiological analysis with additional microorganisms; different microorg. (different microorganisms), JI panel positive result with a different microorganism than that identified by culture.
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