Performance evaluation of a commercial multiplex pathogen panel for the diagnosis of pediatric joint infections

This study evaluates the performance of the BIOFIRE Joint Infection (JI) Panel compared to joint fluid culture and/or 16S rRNA PCR, followed by Sanger sequencing (16S PCR/S) for the diagnosis of joint infections in pediatric patients. An on-panel organism was detected by standard-of-care joint (SOCj) studies (joint fluid culture with or without 16S PCR/S, as ordered by the treating physician) in 29/65 samples (44.6%), and the same organism was detected by the BIOFIRE JI panel in all samples. The cumulative positive percent agreement in the detection of on-panel genus or species-level targets by the BIOFIRE JI panel was 100% (36/36), 100% (25/25), and 100% (27/27), and the negative percent agreement was 99.7% (1,974/1,979), 99.2% (1,974/1,990), and 99.7% (1,303/1,307) compared to detection by SOCj, joint fluid culture only, or 16S PCR/S only, respectively. The potential clinical impact of employing the BIOFIRE JI panel was predicted by retrospective adjudication using a study-specific rubric. We predicted that 27.7% (18/65) of BIOFIRE JI panel results could have had a positive impact on patient care. One case (1.5%) was predicted to potentially have a negative impact, and three cases (4.6%) were adjudicated to have an unknown impact. All organisms detected by 16S PCR/S, but not by culture, were also detected by the BIOFIRE JI panel during this study. IMPORTANCE: The BIOFIRE JI Panel has been limitedly evaluated in pediatric patients. Our study shows a strong agreement between the BIOFIRE JI panel and culture and/or 16S rRNA PCR with Sanger sequencing for the detection of the most common pathogenic causes of joint infection in children. The faster time to results of the BIOFIRE JI panel has the potential to guide optimal treatment faster than conventional methods.