Diagnostic performance comparison of multiplex PCR-based BioFire® joint infection panel and conventional culture methods in septic arthritis: A single center, retrospective study.

OBJECTIVE

Septic arthritis (SA) is a destructive disease requiring urgent diagnosis and treatment. The low sensitivity of conventional culture methods necessitates rapid molecular diagnostic approaches. This study aimed to evaluate the diagnostic performance of the multiplex PCR-based BioFire® Joint Infection Panel (BJIP) compared with BACTEC liquid culture and solid media culture methods in a country with high rates of antibiotic use.

MATERIALS AND METHOD: Synovial fluid samples from 86 patients diagnosed with SA were retrospectively analyzed. Diagnostic performance was compared using sensitivity, specificity, positive and negative predictive values, Cohen's kappa agreement coefficient, and McNemar's test.

RESULTS

The mean patient age was 59.9 ± 17.1 years, and 59.3% were male. The BJIP detected pathogens in 12 patients (14.0%), BACTEC in 9 (10.5%), and solid media in only 3 (3.5%). The detection proportion of BJIP was higher than that of solid media (p = 0.004). No statistically significant difference was found between BJIP and BACTEC detection rates (p = 0.549). Inter-method agreement analysis demonstrated moderate concordance between BJIP and BACTEC (κ = 0.41, p = 0.002) and between BACTEC and solid media (κ = 0.472, p = 0.001), while agreement between BJIP and solid media was fair-to-moderate (κ = 0.37, p = 0.002).

CONCLUSION

The BJIP demonstrated significantly superior detection proportion compared to solid media culture and comparable performance to BACTEC. Given the high rate of prior antibiotic use (69.8%) in our study population, PCR-based methods are particularly recommended, as they provide rapid results and enable detection of pathogens in culture-negative cases.