Antimicrobial Stewardship in Joint Infection Diagnostics

Antimicrobial resistance (AMR) refers to when pathogens become resistant to medications, rendering the latter ineffective in treating both common and severe infections. It is for this reason that AMR is considered one of the greatest health threats of this century.¹

While AMR, to a certain degree, occurs naturally, the overuse of antibiotics is exacerbating the phenomenon.²Compared to illnesses caused by non-resistant pathogens, AMR-related infections have higher morbidity and mortality rates, which is consequently creating a significant burden for the healthcare system.³^,5

Antimicrobial Resistance in Numbers

Top 10¹	2.8 million⁴	35,000⁴
Global public threat	Antimicrobial resistant infections annually in the US	Annual deaths in the US due to AMR-related infections

When it comes to joint infections such as periprosthetic joint infections (PJIs) and septic arthritis, the issue of AMR cannot be ignored. PJIs, for example, are difficult to treat on their own and often require a combination of antibiotic treatment and surgery. But antibiotic medications commonly used to treat some periprosthetic joint infections are becoming increasingly ineffective due to drug-resistant pathogens.²

As life expectancy improves, more people will need joint replacements, joint arthroplasties, and prostheses. And although PJI cases are relatively low, their prevalence will increase.² By 2030, joint infection cases as a whole are projected to cost the US healthcare system $1.85 billion.⁶

Roadblocks to Joint Infection Diagnosis

Joint infections are notoriously difficult to diagnose and require fast treatment to prevent permanent cartilage damage and other debilitating outcomes.^7,8

One of the main sticking points is that there is no gold standard for joint infection testing. Traditional cultures can take up to two weeks to yield a result, and that result may be impacted by prior antibiotic exposure.⁹ For example, PJI cultures fail to identify the infecting pathogen up to 15% of the time.⁹Moreover, polymicrobial infections occur in up to 35% of early-onset stages of PJI, which may make it more difficult for clinicians to obtain a full diagnostic picture.⁹

Meanwhile, patients are often prescribed antibiotic treatment based on symptomology alone, which may contribute to the problem of antimicrobial overuse and result in the likelihood that proper antibiotic treatment may prove ineffective once a diagnosis is set.

Therefore, performing the right test, the first time is essential to joint infection diagnosis and possible treatment.

The Benefits of Syndromic Testing for Joint Infections

The syndromic approach is a diagnostic testing method designed to provide answers on a comprehensive menu of potential pathogen targets. Faster and more streamlined than traditional testing methods, syndromic testing can potentially help clinicians make more informed therapy decisions, especially as they pertain to antimicrobials.¹⁰ Syndromic testing also offers greater sensitivity and specificity compared to traditional testing methods, increasing the chance of identifying a pathogen and differentiating between infectious and non-infectious conditions.¹⁰

How the BIOFIRE^® Joint Infection (JI) Panel Could Promote Antimicrobial Stewardship

The BIOFIRE JI Panel is a multiplexed nucleic-acid-based, in vitro diagnostic test intended for the simultaneous qualitative detection and identification of multiple bacterial and yeast nucleic acids. These include 31 gram-positive bacteria, gram-negative bacteria, and yeast targets, and eight antimicrobial resistance genes.

Unlike in traditional testing, the BIOFIRE JI Panel requires only 0.2mL of synovial fluid and delivers a single report on all targets within about an hour. The speed and accuracy with which the results are delivered may lend to more speedy diagnoses of joint infections, allowing clinicians to make more informed treatment decisions that promote antimicrobial stewardship efforts.

Helpful Resources About BIOFIRE, Joint Infections, and More

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BIOFIRE Solutions

The Syndromic Approach
Antimicrobial Resistance Solutions

BIOFIRE Blog

References:

Antimicrobial resistance. Accessed 10 Oct 2022. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
Stevoska S, et al. Significant Difference in Antimicrobial Resistance of Bacteria in Septic Revision between Total Knee Arthroplasty and Total Hip Arthroplasty. 2022 Feb;11(2): 249.
Frost I, et al. Global geographic trends in antimicrobial resistance: the role of international travel. J Travel Med. 2019 Dec 23;26(8):taz036.
Antibiotic Resistance Threats in the United States 2019. Access 11 Oct 2022. Retrieved from: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
Antibiotic Resistance Threats in the United States 2013. Accessed 10 Oct 2022. Retrieved from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf
Premkumar A, et al. Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States. J Arthroplasty. 2021 May;36:1484-1489.e3.
Costales C, et al. A Real Pain: Diagnostic Quandaries and Septic Arthritis. J Clin Microbiol. 2018 Jan 24;56(2):e01358-17.
Garcia-Arias M, et al. Best Pract Res Clin Rheumatol. Septic arthritis. 2011 Jun;25(3):407-21.
Tande JT, et al. Microbiol Rev. Prosthetic Joint Infection. 2014 Apr; 27(2): 302–345.
Esteban J, et al. Multicenter evaluation of the BIOFIRE Joint Infection Panel for the detection of bacteria, yeast, and AMR genes in synovial fluid samples. Journal of Clinical Microbiology. 25 October, 2023. https://doi.org/10.1128/jcm.00357-23