Journal of Bone and Joint Infection · Published 2025-11-05 · DOI 10.5194/jbji-10-437-2025
<p><strong>Aim</strong>: The aim of this study was to investigate the diagnostic performance of a novel rapid multiplex polymerase chain reaction (mPCR) in adults with suspected acute native joint infection. <strong>Methods</strong>: This retrospective single-centre study included 143 patients with suspected acute native joint infection from February 2023 to May 2024. A septic arthritis was classified based on institutional criteria. The agreement between mPCR and conventional culture of synovial fluid (SF) was assessed by calculating the Cohen's <span class="inline-formula"><i>κ</i></span> coefficient. The diagnostic performance of mPCR was calculated, and the area under the curve (AUC) was compared with conventional culture of synovial fluid by using the <span class="inline-formula"><i>z</i></span> test. <strong>Results</strong>: When considering only microorganisms targeted by mPCR, this method detected 13 novel microorganisms in 13 cases compared to conventional culture, resulting in an overall agreement of 91 %, a positive agreement of 100 %, a negative agreement of 88 %, and a Cohen's <span class="inline-formula"><i>κ</i></span> coefficient of 0.780. Of these 13 cases, 9 were classified as septic, with 6 (<span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M4" display="inline" overflow="scroll" dspmath="mathml"><mrow><mi>n</mi><mo>=</mo><mn mathvariant="normal">6</mn><mo>/</mo><mn mathvariant="normal">9</mn></mrow></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="39pt" height="14pt" class="svg-formula" dspmath="mathimg" md5hash="ac08491c42288ee2ec88ee3013a2c961"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jbji-10-437-2025-ie00001.svg" width="39pt" height="14pt" src="jbji-10-437-2025-ie00001.png"/></svg:svg></span></span>, 67 %) on antibiotics prior to aspiration. When considering all microorganisms (including off-panel microorganisms), the overall percentage agreement between mPCR and conventional culture was 89 %, with a Cohen's <span class="inline-formula"><i>κ</i></span> coefficient of 0.735, indicating substantial agreement. Sensitivity, specificity, PPV, NPV, LR<span class="inline-formula">+</span>, LR<span class="inline-formula">−</span>, accuracy, and AUC of mPCR were 45 %, 89 %, 90 %, 44 %, 4.21, 0.62, 59 %, and 0.671, and those of conventional culture were 40 %, 100 %, 100 %, 45 %, 0.60, 59 %, and 0.698. No difference in performance was observed between both methods (<span class="inline-formula"><i>p</i>=0.183</span>). The combination of both techniques showed a sensitivity, specificity, PPV, NPV, LR<span class="inline-formula">+</span>, LR<span class="inline-formula">−</span>, accuracy, and AUC of 48 %, 89 %, 90 %, 46 %, 4.5, 0.58, 62 %, and 0.686. <strong>Conclusion</strong>: Given its comparable diagnostic performance and faster turnaround time relative to conventional synovial fluid culture, this novel mPCR can be recommended as a valuable adjunct in the diagnosis of septic arthritis in adults, particularly in patients with prior antimicrobial treatment.</p>
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