Performance of the BIOFIRE® Joint Infection Panel in the diagnosis of osteoarticular infections in adults and children in Santiago, Chile

Purpose To evaluate the diagnostic performance and clinical utility of the BIOFIRE® Joint Infection multiplex PCR panel compared to conventional culture and 16S rRNA sequencing for the diagnosis of acute osteoarticular infections (OAI) in a Latin American setting. Methods A prospective study was conducted between August 2022 and January 2024 at two tertiary hospitals in Santiago, Chile, involving a dual cohort of 124 adults and 32 children. A total of 156 samples (synovial fluid and osteoarticular tissue) were analyzed. JI panel's performance was compared against a Composite Reference Standard (CRS) consisting of standard-of-care culture and universal 16S rRNA PCR with sequencing. Results Staphylococcus aureus was the predominant pathogen identified in both cohorts (49.3% by culture vs. 46.8% by JI). For all on-panel microorganisms, the JI panel demonstrated an overall sensitivity of 90.9% (95% CI: 81.3–96.6%) and a negative predictive value (NPV) of 92.4% (95% CI: 84.2–97.2%). In the pediatric population, the panel achieved a specificity of 95.2% and an NPV of 95.2%. Notably, the JI panel maintained high performance in 20.5% of patients with prior antibiotic exposure and successfully identified polymicrobial infections that were missed or underreported by traditional cultures. Conclusions The JI panel is a rapid, highly accurate tool for the microbiological documentation of OAIs in real-world clinical settings in Latin America. Its high NPV and rapid turnaround time (65 minutes) support its integration into diagnostic stewardship algorithms to optimize early and optimal antimicrobial therapy, particularly in pediatric cases and patients with suspected fastidious or culture-negative infections.