Lin Tsung-Li, Yeh Chen-Wei, Tsai Chun-Hao, Ho Mao-Wang, Lin Hsiu-Hsien, Hsueh Po-Ren
Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.
Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan.
Microbiol Spectr. 2025 Jun 18:e0028625. doi: 10.1128/spectrum.00286-25.
The BioFire Joint Infection (JI) Panel is a multiplex polymerase chain reaction assay developed for rapid pathogen detection in synovial fluid, particularly for suspected prosthetic joint infections (PJI). However, its diagnostic sensitivity varies by clinical context and pathogen, and the impact of prior antibiotic exposure on sample quality and PJI stewardship remains unclear. This prospective study evaluated the diagnostic performance of the Investigational Use Only JI Panel versus conventional synovial fluid culture, using Musculoskeletal Infection Society criteria and symptom onset within 3 weeks to define acute PJI. Fifty-four fresh synovial fluid samples from patients with suspected knee PJI were analyzed. In acute PJI, the JI Panel demonstrated comparable sensitivity to synovial fluid culture (80% vs. 95%; = 0.096), while significantly reducing time to pathogen identification (mean 18.2 vs. 84.6 hours, < 0.001), enabling earlier targeted antibiotic therapy in 83.3% of cases. Overall sensitivity across all PJI cases was moderate (50%) and significantly lower in chronic PJI (16.7%), reflecting limited panel coverage and reduced detection in prolonged infections. Prior antibiotic exposure reduced sensitivity for both methods, though not significant ( = 0.127). The absence of key pathogens such as and further limited diagnostic yield in chronic cases. The JI Panel offers a rapid and clinically impactful tool for diagnosing acute PJI and guiding antibiotic stewardship. However, its limitations in chronic PJI and susceptibility to antibiotic pretreatment restrict its standalone diagnostic utility. Therefore, it should complement, not replace, traditional culture methods, particularly in chronic PJI cases.IMPORTANCEThe JI Panel demonstrates high sensitivity for acute PJI but lower sensitivity for chronic infections. The ability of the JI Panel to rapidly identify pathogens in acute cases plays a significant role in improving antibiotic stewardship, ensuring timely and appropriate treatment. Given the lower sensitivity for chronic PJI, further research could focus on improving the detection of pathogens that are commonly involved in chronic infections. While the JI Panel is a promising tool for acute PJI diagnosis and supports rapid antibiotic stewardship, its limitations in chronic cases and under antibiotic exposure must be addressed to maximize its clinical utility.
BioFire关节感染（JI）检测板是一种多重聚合酶链反应检测方法，专为在滑液中快速检测病原体而开发，特别是用于疑似人工关节感染（PJI）。然而，其诊断敏感性因临床背景和病原体而异，先前抗生素暴露对样本质量和PJI管理的影响仍不明确。这项前瞻性研究使用肌肉骨骼感染学会标准以及3周内的症状发作来定义急性PJI，评估了仅供研究使用的JI检测板与传统滑液培养的诊断性能。对54例疑似膝关节PJI患者的新鲜滑液样本进行了分析。在急性PJI中，JI检测板显示出与滑液培养相当的敏感性（80%对95%；P = 0.096），同时显著缩短了病原体鉴定时间（平均18.2小时对84.6小时，P < 0.001），使83.3%的病例能够更早地接受针对性抗生素治疗。所有PJI病例的总体敏感性为中等（50%），在慢性PJI中显著更低（16.7%），这反映出检测板覆盖范围有限以及在长期感染中的检测率降低。先前抗生素暴露降低了两种方法的敏感性，尽管不显著（P = 0.127）。慢性病例中缺乏关键病原体如[未提及具体病原体名称]进一步限制了诊断率。JI检测板为诊断急性PJI和指导抗生素管理提供了一种快速且具有临床影响力的工具。然而，其在慢性PJI中的局限性以及对抗生素预处理的敏感性限制了其独立诊断效用。因此，它应补充而非取代传统培养方法，特别是在慢性PJI病例中。重要性JI检测板对急性PJI显示出高敏感性，但对慢性感染的敏感性较低。JI检测板在急性病例中快速鉴定病原体的能力在改善抗生素管理、确保及时和适当治疗方面发挥着重要作用。鉴于对慢性PJI的敏感性较低，进一步的研究可以集中在改善对慢性感染中常见病原体的检测上。虽然JI检测板是急性PJI诊断的一种有前途的工具并支持快速抗生素管理，但其在慢性病例中的局限性以及在抗生素暴露情况下的问题必须得到解决，以最大限度地发挥其临床效用。
