In acute bacterial infections of native and prosthetic joints, prompt recognition and treatment are required. In acute osteoarticular infections (OIs), including periprosthetic joint infections (PJIs), fracture-related infections (FRIs), surgical site infections (SSIs), and native septic arthritis, ongoing biofilm formation results in bacterial recalcitrance to antimicrobial therapy [1]. Biofilm-forming bacteria transform into slow metabolic forms, including the viable but non-culturable state [2]. Therefore, the prompt recognition and identification of the causative microorganisms and their susceptibility to antimicrobials are crucial for successful treatment. The conventional diagnostic pathway includes initial microscopy and culture, colony selection and identification of pathogens, and subculture for purity. Antimicrobial susceptibility testing takes an additional 48–72 h, including data analysis. Conventional culture methods remain the gold standard for the microbiological diagnosis of OIs but have several limitations, such as a long turnaround time and false-negative results in patients receiving antibiotics. Although the sensitivity of the culture method has improved using techniques such as sonication [[3], [4], [5], [6], [7]], patients with clinically suspected OIs and negative culture results persist. In this context, several molecular techniques have been developed in recent years to accelerate diagnosis and improve the sensitivity and specificity of microbiological diagnosis.

Polymerase chain reaction (PCR) is a powerful tool for the rapid identification of specific pathogens or genes, providing results faster compared to the culture method and identifying difficult-to-culture pathogens [[8], [9], [10], [11], [12]]. Advances have been made in rapid diagnostics, including rapid multiplex PCR for identification of pathogens and antimicrobial resistance (AMR) gene detection, which takes approximately 24 h [13]. While previous genetic tests required specific equipment and specialized expertise, the fully automated syndrome multiplex PCR panel, BIOFIRE® FilmArray® Joint Infection Panel (JI panel) [[14], [15], [16], [17]], requires minimal instrumentation and kits, and the results are determined by the instrument for approximately 1 h, eliminating the requirement for specialized expertise. The utility of the JI panel has already been reported in numerous medical specialties [[14], [15], [16], [17], [18]]. However, previous studies using the JI panel had insufficient clinical data for all patients [15,18]; therefore, accurate evaluation of the results based on patient clinical courses was difficult. In the present study, this challenge was addressed by a detailed evaluation that included JI panel-negative cases. Including clinical data allowed a more thorough evaluation of various clinical syndromes.