Advances in Rapid Molecular Blood Culture Diagnostics: Healthcare Impact, Laboratory Implications, and Multiplex Technologies

J Appl Lab Med. 2019 Jan;3(4):617-630. doi: 10.1373/jalm.2018.027409. Epub 2018 Nov 21.

Abstract

Background: For far too long, the diagnosis of bloodstream infections has relied on time-consuming blood cultures coupled with traditional organism identification and susceptibility testing. Technologies to define the culprit in bloodstream infections have gained sophistication in recent years, notably by application of molecular methods.

Content: In this review, we summarize the tests available to clinical laboratories for molecular rapid identification and resistance marker detection in blood culture bottles that have flagged positive. We explore the cost-benefit ratio of such assays, covering aspects that include performance characteristics, effect on patient care, and relevance to antibiotic stewardship initiatives.

Summary: Rapid blood culture diagnostics represent an advance in the care of patients with bloodstream infections, particularly those infected with resistant organisms. These diagnostics are relatively easy to implement and appear to have a positive cost-benefit balance, particularly when fully incorporated into a hospital's antimicrobial stewardship program.

Publication types

  • Review

MeSH terms

  • Anti-Infective Agents / pharmacology
  • Anti-Infective Agents / therapeutic use
  • Antimicrobial Stewardship / economics
  • Antimicrobial Stewardship / methods
  • Antimicrobial Stewardship / trends*
  • Bacteremia / diagnosis*
  • Bacteremia / drug therapy
  • Bacteremia / economics
  • Bacteremia / microbiology
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Bacterial Proteins / genetics
  • Bacterial Proteins / isolation & purification
  • Blood Culture / economics
  • Blood Culture / methods*
  • Blood Culture / trends
  • Clinical Laboratory Services / economics
  • Clinical Laboratory Services / organization & administration
  • Clinical Laboratory Services / trends*
  • Cost-Benefit Analysis
  • DNA, Bacterial / isolation & purification
  • DNA, Fungal / isolation & purification
  • Drug Resistance, Bacterial / genetics
  • Drug Resistance, Fungal / genetics
  • Fungal Proteins / genetics
  • Fungal Proteins / isolation & purification
  • Fungemia / diagnosis*
  • Fungemia / drug therapy
  • Fungemia / economics
  • Fungemia / microbiology
  • Fungi / genetics
  • Fungi / isolation & purification
  • Genotyping Techniques / economics
  • Genotyping Techniques / instrumentation
  • Genotyping Techniques / methods
  • Health Care Costs
  • Humans
  • Microbial Sensitivity Tests / instrumentation
  • Microbial Sensitivity Tests / methods
  • Time Factors
  • Time-to-Treatment

Substances

  • Anti-Infective Agents
  • Bacterial Proteins
  • DNA, Bacterial
  • DNA, Fungal
  • Fungal Proteins