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. 2022 Dec 21;60(12):e0112622.
doi: 10.1128/jcm.01126-22. Epub 2022 Nov 21.

Comparison of the BioFire Joint Infection Panel to 16S Ribosomal RNA Gene-Based Targeted Metagenomic Sequencing for Testing Synovial Fluid from Patients with Knee Arthroplasty Failure

Marisa A Azad  1   2 , Matthew J Wolf  2 , Angela P Strasburg  2 , Matthew L Daniels  2 , Jordan C Starkey  2 , Alexander D Donadio  2 , Matthew P Abdel  3 , Kerryl E Greenwood-Quaintance  2 , Robin Patel  1   2
Affiliations

Comparison of the BioFire Joint Infection Panel to 16S Ribosomal RNA Gene-Based Targeted Metagenomic Sequencing for Testing Synovial Fluid from Patients with Knee Arthroplasty Failure

Marisa A Azad et al. J Clin Microbiol. .

Abstract

The diagnosis of periprosthetic joint infection (PJI) is challenging, often requiring multiple clinical specimens and diagnostic techniques, some with prolonged result turnaround times. Here, the diagnostic performance of the Investigational Use Only (IUO) BioFire Joint Infection (JI) Panel was compared to 16S rRNA gene-based targeted metagenomic sequencing (tMGS) applied to synovial fluid for PJI diagnosis. Sixty synovial fluid samples from knee arthroplasty failure archived at -80°C were tested. Infectious Diseases Society of America (IDSA) diagnostic criteria were used to classify PJI. For culture-positive PJI with pathogens targeted by the JI panel, JI panel sensitivity was 91% (21/23; 95% confidence interval [CI], 73 to 98%), and tMGS sensitivity was 96% (23/24; 95% CI, 80 to 99%) (P = 0.56). Overall sensitivities of the JI panel and tMGS for PJI diagnosis were 56% (24/43; 95% CI, 41 to 70%) and 93% (41/44; 95% CI, 82 to 98%), respectively (P < 0.001). JI panel and tMGS overall specificities were 100% (16/16; 95% CI, 81 to 100%) and 94% (15/16; 95% CI, 72 to 99%), respectively. While the clinical sensitivity of the JI panel was excellent for on-panel microorganisms, overall sensitivity for PJI diagnosis was low due to the absence of Staphylococcus epidermidis, a common causative pathogen of PJI, on the panel. A PJI diagnostic algorithm for the use of both molecular tests is proposed.

Keywords: PCR; next-generation sequencing; periprosthetic joint infection; rapid diagnostic.

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Conflict of interest statement

The authors declare a conflict of interest. M.A.A., M.J.W., A.P.S., M.L.D., J.C.S., A.D.D., M.P.A., and K.E.G.-Q. have no conflicts of interests to declare. R.P. reports grants from ContraFect, TenNor Therapeutics Limited, and BioFire. R.P. is a consultant to Curetis, Next Gen Diagnostics, PathoQuest, Selux Diagnostics, 1928 Diagnostics, PhAST, Torus Biosystems, Day Zero Diagnostics, Mammoth Biosciences, and Qvella; monies are paid to Mayo Clinic. Mayo Clinic and R.P. have a relationship with Pathogenomix. R.P. has research supported by Adaptive Phage Therapeutics. Mayo Clinic has a royalty-bearing know-how agreement and equity in Adaptive Phage Therapeutics. R.P. is also a consultant to Netflix and CARB-X. In addition, R.P. has a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued. R.P. receives honoraria from the NBME, Up-to-Date and the Infectious Diseases Board Review Course.

Figures

FIG 1
FIG 1
Proposed algorithm for use of the BioFire Joint Infection (JI) Panel and targeted metagenomic sequencing (tMGS) for the diagnosis of periprosthetic joint infection (PJI). *, symptoms consistent with PJI may include joint pain, erythema, and swelling; wound drainage or dehiscence; fever; and difficulty weight bearing on the affected joint; **, synovial fluid analysis includes aerobic and anaerobic cultures, total cell count with differential, and microscopic analysis for crystals; the interpretation should be made in conjunction with clinical presentation, and timing of infection, with or without additional diagnostic markers, such as synovial fluid alpha defensin and/or leukocyte esterase.
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References

    1. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. 2012. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 27:61–65.E1. doi: 10.1016/j.arth.2012.02.022. - DOI - PubMed
    1. Lamagni T. 2014. Epidemiology and burden of prosthetic joint infections. J Antimicrob Chemother 69(Suppl 1):i5–i10. doi: 10.1093/jac/dku247. - DOI - PubMed
    1. Premkumar A, Kolin DA, Farley KX, Wilson JM, McLawhorn AS, Cross MB, Sculco PK. 2021. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 36:1484–1489.e3. doi: 10.1016/j.arth.2020.12.005. - DOI - PubMed
    1. Helwig P, Morlock J, Oberst M, Hauschild O, Hübner J, Borde J, Südkamp NP, Konstantinidis L. 2014. Periprosthetic joint infection—effect on quality of life. Int Orthop 38:1077–1081. doi: 10.1007/s00264-013-2265-y. - DOI - PMC - PubMed
    1. Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR, The OSIRIS Collaborative Study Group . 1998. Prospective evaluation of criteria for microbiological diagnosis of prosthetic joint infection at revision arthroplasty. J Clin Microbiol 36:2932–2939. doi: 10.1128/JCM.36.10.2932-2939.1998. - DOI - PMC - PubMed

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