Clinical performance of a syndromic panel for direct identification of pathogens and antimicrobial resistance markers in pediatric osteoarticular and pleural space infections.

Abstract

The recovery of microbial pathogens from sterile body fluids in children poses challenges, including the low sensitivity of conventional culture. Pre-treatment with empiric antimicrobials can render the pathogen non-viable. In such cases, and with fastidious organisms like Kingella kingae, molecular methods are useful for identification of the causative agent. This study evaluated the clinical performance of the bioMérieux BIOFIRE Joint Infection (JI) Panel to standard-of-care (SOC) diagnostic techniques in pediatric osteoarticular and pleural fluid and abscess specimens. A total of 136 specimens (77 joint and 59 pleural), were tested with the JI Panel. SOC methods included a lab-developed, real-time PCR assay (Laboratory-developed PCR [LDT-PCR]), routine culture and ancillary testing. Compared to the composite SOC methods, the JI Panel had a positive percent agreement (PPA) of 90.1% and negative percent agreement (NPA) of 99.9% for the detection of on-panel organisms in osteoarticular specimens. For pleural specimens, the JI Panel had a PPA of 93.8% and NPA of 99.6%. False negatives by the JI Panel in both specimen types were detected by the LDT-PCR with cycle thresholds ≥35, which may suggest a low burden of microorganisms in these specimens. The JI Panel demonstrated good performance for the detection of K. kingae (PPA = 93.8%) in osteoarticular specimens and Streptococcus pneumoniae (PPA = 95.2%) in pleural specimens, the most common pediatric pathogens identified in these respective specimen types. The JI Panel has the potential to impact the treatment and management of pediatric patients, especially in culture-negative cases.

Importance: The identification of the causative agents of osteoarticular and pleural space infections in children is challenging, as routine bacterial cultures often yield no growth. The BIOFIRE Joint Infection Panel is a rapid, multiplex PCR assay that detects a wide range of microorganisms and antimicrobial resistance genes. This study demonstrates that the panel has good agreement with standard of care methods for the detection of common pediatric pathogens and may aid in the rapid diagnosis of osteoarticular and pleural space infections in children. However, it is recommended that the assay be used in conjunction with standard bacterial cultures and results interpreted within the context of the clinical presentation, since false-negative and false-positive results may occur.