Evaluation of the BioFire joint infection panel in Taiwan: Impact of regional non-target pathogens and joint type on its performance.

OBJECTIVES

The BIOFIRE® Joint Infection (BJI) panel, a rapid multiplex polymerase chain reaction assay, is used to diagnose joint infections. Here we used it to evaluate the clinical performance and impact of antimicrobial resistance (AMR) detection in Taiwan's unique microbial landscape.

METHODS

Adult patients with suspected septic arthritis or prosthetic joint infection were prospectively enrolled from four hospitals in southern Taiwan. Synovial fluid specimens were tested using a BJI panel and routine bacterial culturing. Performance was assessed by calculating the positive percent agreement and negative percent agreement (PPA and NPA, respectively).

RESULTS

Eighty-six specimens (native joints, 56; prosthetic joints, 30) were analyzed. The overall PPA and NPA were 92.3% and 76.7%, respectively. Native joints showed higher concordance (PPA, 93.8%; NPA, 85.0%) than prosthetic joints (PPA, 90.0%; NPA, 60.0%). The BJI panel detected pathogens in 14 culture-negative cases, predominantly among patients who previously received antibiotics. Notably, the panel identified six methicillin-resistant Staphylococcus aureus cases (three culture-negative) and one blaCTX-M-positive E. coli detection. However, three culture-positive cases involving "off-panel" regional pathogens (Burkholderia pseudomallei, n = 2; Mycobacterium tuberculosis complex, n = 1) were BJI-negative. Diagnostic concordance is better in native joints and correlated significantly with higher synovial leukocyte counts.

CONCLUSIONS

Our evaluation revealed the BJI panel's ability to rapidly identify pathogens and profile AMR, with additional diagnostic yield particularly in culture-negative prosthetic joint infections and in patients with prior antibiotic exposure. However, its limited detection targets leave a diagnostic gap for regionally endemic pathogens such as Burkholderia pseudomallei and Mycobacterium tuberculosis complex, indicating the continued need for conventional culturing.