Blood culture-based detection of bloodstream infections

Bloodstream infections (BSIs) are associated with adverse clinical and health-economic outcomes [1,2]. Th irty to forty percent of all cases of severe sepsis and septic shock are culture-proven BSIs, for which there is a rapid decline in survival rates in cases where inadequate antimicrobial therapy is administered within the fi rst 24 hours [3,4]. As a consequence, clinicians often resort to empirical broadspectrum antimicrobial therapy favoring the selection and spread of resistant pathogens (i.e., extended spectrum β-lactamase producing organisms) [5], increased invasive fungal infections [6,7], rising consumption of more expensive third-line drugs (e.g. tigecycline, daptomycine) [8] and drug toxicity issues (e.g. colistin) [9,10]. Rapid detection of BSIs with determination of antibiotic susceptibility can alter current practices in infection control, therapeutic management, and clinical decision-making and ultimately reduce over-prescription of antimicrobials and associated adverse outcomes [11,12]. Th is article will present recent technological developments, discuss the shortcomings and advantages of culture-based and molecular diagnostics and describe the requirements for an ideal rapid diagnostic system.