Performance and potential utility of the BioFire Joint Infection Panel with synovial fluid and joint tissue specimens

ABSTRACT The BioFire Joint Infection Panel (BJIP) (bioMérieux) is a rapid sample-to-answer multiplex polymerase chain reaction (PCR) platform for the diagnosis of joint infections. This retrospective study evaluated its performance with synovial fluid and joint tissue specimens from native and prosthetic joints. Joint fluid and tissue specimens received from November 2023 to September 2024 were included. Some specimens were pooled prior to BJIP testing. BJIP results were compared to composite standard laboratory testing (culture, 16S rRNA gene PCR and sequencing [where performed], and concurrent microbiological results for that infection episode). Clinical data were collected (diagnosis, surgical history, antibiotic treatment). Subgroup analysis of native and prosthetic joint specimens was conducted. There were 224 specimens from 134 patients: 107 synovial fluids and 117 joint tissues. The most common organisms, reliably detected by the BJIP, were Staphylococcus aureus and Streptococcus spp. The on-panel positive percent agreement (PPA) was 90.5% for synovial fluids and 86.8% for joint tissues. There was no significant difference in the PPA for synovial fluids vs joint tissues, nor for native vs prosthetic joints. The additional diagnostic yield was one case. The absence of important pathogens in prosthetic joint infection, e.g., Cutibacterium acnes , reduces the overall PPA (74.5% synovial fluid, 77.6% joint tissue). The BJIP performs well in synovial fluid and joint tissue specimens, from native and prosthetic joints for on-panel organisms. There was minimal additional diagnostic yield. We suggest an implementation pathway using the BJIP upfront to provide rapid results to optimize patient care. IMPORTANCE This study compared the BioFire Joint Infection polymerase chain reaction panel to standard culture-based methods for detecting organisms causing joint infections. This is a relatively new test, and the data published so far show it performs well with synovial fluid. There are limited published data using it for joint tissue specimens. We found that the BioFire Joint Infection Panel reliably detects pathogens in synovial fluid and joint tissue specimens, though its performance is limited by the absence of important pathogens associated with prosthetic joint infection, e.g., Cutibacterium acnes . We suggest using the panel to provide rapid diagnosis to optimize patient care.