Search Results (1,077)

Objective: Our objective was to investigate the association between serum phosphorus levels and 28-day mortality in patients with bloodstream infection (BSI), and to explore whether this association persists after adjusting for renal function and clinical severity. Methods: This retrospective cohort study included 214 BSI patients. Patients were divided into hyperphosphatemia (≥2.2 mmol/L, n = 15) and control (<2.2 mmol/L, n = 199) groups. To address the small sample size and potential separation, multivariate Firth’s penalized likelihood regression was utilized to evaluate the association with 28-day mortality. Restricted cubic spline regression explored the continuous relationship. Fine–Gray competing risk models, 1000-resample bootstrapping, and E-value analyses were conducted to ensure the robustness of the observed associations. Results: The 28-day mortality rate was significantly higher in the hyperphosphatemia group (80.0% vs. 39.7%, p = 0.005). After adjusting for age, sex, and estimated glomerular filtration rate (eGFR), hyperphosphatemia remained significantly associated with higher observed 28-day mortality (OR = 4.46, 95% CI: 1.36–18.54, p = 0.012). This association remained robust even after further adjustment for septic shock (OR = 4.74, 95% CI: 1.30–21.64, p = 0.017). Analyzed continuously, each 0.5 mmol/L increase in serum phosphorus was associated with 34% higher odds of mortality (OR = 1.34, 95% CI: 1.07–1.74, p = 0.01). Spline analysis confirmed a nonlinear relationship with a threshold at 2.2 mmol/L. Kaplan–Meier analysis demonstrated a severity-driven survival separation in the hyperphosphatemia group (Log-rank p < 0.001). The association remained highly robust after adjusting for early discharge competing risks (sHR = 4.62, p < 0.001) and in bootstrap validation (median OR = 4.80). Conclusions: Serum phosphorus ≥ 2.2 mmol/L is associated with higher observed mortality in BSI patients, an association that remained evident after adjusting for renal function and clinical severity, including septic shock. However, given the small hyperphosphatemia subgroup (n = 15), limited statistical stability, and the potential for residual confounding, these findings should be considered hypothesis-generating rather than definitive, requiring prospective validation in larger, adequately powered cohorts. Rather than a definitive triage tool, serum phosphorus may serve as a simple, adjunctive marker for early metabolic assessment in severe infections. Full article

Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand hygiene interventions and clinical HAI outcomes in acute care hospitals. Methods: A structured literature search was conducted in PubMed, Scopus, Embase, and Google Scholar using a combination of Medical Subject Headings (MeSH) and free-text terms related to hand hygiene, healthcare-associated infections, hospital settings, and intervention strategies. Eligible studies were quasi-experimental designs, including before–after, controlled before–after, and interrupted time-series studies, evaluating multimodal hand hygiene interventions implemented at hospital-wide or multi-ward level and reporting clinical HAI outcomes. Two reviewers independently assessed risk of bias using the ROBINS-I tool, and certainty of evidence across major outcome categories was summarized using GRADE. Results: twelve studies met the inclusion criteria. Overall, multimodal hand hygiene interventions were generally associated with favorable directional trends in clinical outcomes. Reductions were most consistent for broader institutional HAI measures and some device-associated infections, particularly central line-associated bloodstream infections. In contrast, organism-specific outcomes, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, were more heterogeneous across studies and settings. All included studies were judged to be at serious or critical overall risk of bias, primarily because of confounding, lack of contemporaneous controls, co-interventions, and phased implementation. Conclusions: Multimodal hand hygiene programs in acute care hospitals may be associated with improvement in selected clinically relevant HAI outcomes, particularly at the institutional level. However, the overall certainty of evidence remains low to very low, and the strength of inference is limited by the non-randomized nature of the available studies and the difficulty of isolating the independent effect of hand hygiene within complex infection-prevention strategies. Full article

Background/Objectives: Central line-associated bloodstream infection (CLABSI) remains a major healthcare-associated infection in intensive care units (ICUs). This study evaluated changes in CLABSI incidence following the implementation of a multimodal infection control intervention in the ICU. Methods: We conducted a quasi-experimental study in the adult ICUs of a referral hospital from January 2023 to December 2025. The interventions included staff education, performance feedback, infection control-led rounds, optimization of catheter practices, and reinforcement of environmental hygiene. The primary outcome was CLABSI incidence per 1000 central line-days. An interrupted time-series analysis using segmented Poisson regression with robust standard errors was used to assess temporal trends. Results: A total of 17 CLABSI cases occurred during the pre-intervention period, and 25 during the post-intervention period. There was no significant difference in CLABSI incidence between the two periods (incidence rate ratio, 1.07; 95% confidence interval, 0.58–1.98). However, interrupted time-series analysis demonstrated a significant decreasing trend in CLABSI incidence following the intervention (rate ratio, 0.89 per month; 95% confidence interval, 0.81–0.97; p = 0.01). This trend was observed despite the higher patient severity and increased use of advanced supportive therapies in the post-intervention period. The device utilization ratio and monthly blood culture rate remained unchanged. Avoidance of femoral venous access increased, and adherence to catheter-handling protocols significantly improved. Conclusions: A staged, multimodal intervention was associated with a significant decreasing trend in CLABSI incidence over time, suggesting a potential benefit of comprehensive infection prevention strategies in ICU settings. Full article

Background: Serum amyloid A (SAA) is an acute-phase reactant that increases rapidly in response to inflammatory stimuli and infection, earlier and more markedly than conventional markers such as C-reactive protein (CRP). However, large-scale evidence of its clinical utility in bloodstream infections (BSIs) remains limited. This study aimed to evaluate the diagnostic and prognostic value of SAA in patients presenting to the emergency department (ED) with suspected infection. Methods: We retrospectively reviewed the electronic medical records of adult patients who underwent simultaneous SAA and blood culture (BC) testing at the ED of a tertiary referral hospital between January and December 2025. Initial laboratory data, including CRP, procalcitonin (PCT), white blood cell (WBC) count, and absolute neutrophil count (ANC), were collected, and BSI was defined as the isolation of pathogenic organisms in BC. Correlations and agreement between SAA and other markers were assessed, and the diagnostic performance of BSI was evaluated using receiver operating characteristic curves and the area under the curve (AUC). Survival outcomes were analyzed using the Kaplan–Meier method. Results: Among the 3321 included patients, 379 patients (11.4%) had positive BCs. Median SAA levels were significantly higher in BSI patients than in non-BSI patients (202.0 vs. 71.0 mg/L, p < 0.001), with the highest levels observed in Gram-negative infections. SAA showed a strong correlation with CRP (r_s = 0.884) and a moderate correlation with PCT (r_s = 0.576). The AUC for BSI diagnosis was highest for PCT (0.789), followed by SAA (0.650). The SAA demonstrated high sensitivity (90.5%) but low specificity (26.9%). Higher SAA levels were significantly associated with increased mortality rates. Conclusions: In adult ED patients, SAA is significantly associated with BSI and mortality and is a sensitive biomarker for the early detection of BSIs. Although SAA alone showed inferior discriminative performance compared to PCT, it may serve as an adjunctive screening tool in the ED, particularly in settings where PCT availability is limited. Full article

Evidence on hospitalised COVID-19 patients during the Omicron BA.5 wave from Eastern European, vaccine-heterogeneous cohorts remains limited. We conducted a retrospective single-centre cohort study of 395 consecutive adults admitted with laboratory-confirmed COVID-19 to a tertiary infectious-diseases unit in western Romania between 1 July and 31 October 2022. Median age was 72 years (IQR 65–81); 33.2% were unvaccinated, 42.8% had documented prior SARS-CoV-2 infection, and 41.3% were obese. Multivariable logistic regression identified independent predictors of in-hospital mortality and post-acute symptom burden. In-hospital mortality was 15.7% (62/395). Vaccination was independently associated with lower mortality (adjusted odds ratio [aOR] 0.55, 95% CI 0.30–0.99; p = 0.048), as was each 1% increase in admission SpO₂ (aOR 0.83, 95% CI 0.76–0.92; p < 0.001), whereas COPD independently increased mortality risk (aOR 2.42, 95% CI 1.15–5.10; p = 0.020). Interleukin-6 was the most discriminating admission biomarker for in-hospital mortality (AUROC 0.70). Bloodstream bacterial co-infection, detected in 22.5% of patients tested on clinical suspicion, was dominated by gut-derived organisms with case-fatality ≥30%. At discharge, 90.1% reported persistent symptoms, most commonly cognitive (24.6%). Prior SARS-CoV-2 infection independently predicted post-acute symptom burden (aOR 2.96, 95% CI 1.75–5.01; p < 0.001), with a specific cardiopulmonary signature. In this BA.5 cohort, vaccination remained protective; IL-6 was the most informative admission biomarker; bloodstream infections suggested gut translocation; and prior infection was an independent determinant of early post-acute symptom burden. Full article

Background and Objectives: Major burn injury causes profound hypermetabolism and altered thermoregulation. While perioperative hypothermia is linked to adverse outcomes, the prognostic significance of preoperative core temperature in major burn patients remains poorly defined. Therefore, we investigated the association between preoperative core temperature and postoperative mortality in patients with major burns. Materials and Methods: This retrospective study included 635 adult patients with major burns who underwent surgery. Preoperative core temperature was measured in the intensive care unit before surgery. The primary outcome was 90-day postoperative mortality. Secondary outcomes were 30-day postoperative complications, including major adverse cardiovascular events (MACE), bloodstream infection, and continuous renal replacement therapy (CRRT) requirement. Cox proportional hazards regression, receiver operating characteristic (ROC) curve, Kaplan–Meier survival, and restricted cubic spline analyses were performed. Results: The 90-day postoperative mortality rate was 35.6%. Mortality increased in a graded manner as preoperative core temperature decreased. In multivariable Cox regression analysis, preoperative core temperature remained independently associated with 90-day mortality. Restricted cubic spline analysis showed an inverse linear association between preoperative core temperature and mortality risk. ROC curve analysis identified 37.0 °C as an exploratory and hypothesis-generating cohort-specific threshold for risk stratification. Regarding secondary outcomes, the core temperature ≤37.0 °C group had higher rates of MACE, bloodstream infections, and CRRT requirement (all p < 0.05). Conclusions: Lower preoperative core temperature was associated with increased 90-day postoperative mortality in adults with major burns undergoing surgery. Preoperative temperature may serve as a clinically relevant marker of physiologic vulnerability and postoperative risk. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKp) remains a critical driver of antimicrobial resistance (AMR) in hospital settings worldwide. Methods: This study examined trends in CRKp bloodstream infections over a seven-year period (2019–2025) in a tertiary care hospital in Greece, with particular attention given to resistance patterns and patient outcomes, including the impact of the COVID-19 pandemic. Results: A total of 671 non-duplicate CRKp isolates were analyzed and classified into three groups: KPC producers (67.4%), dual carbapenemase producers (dual CP) (17.4%), and single metallo-β-lactamase (MBL) producers (15.2%). Overall incidence showed a slight but non-significant increase over time. KPC-producing strains rose significantly until 2022 (p < 0.001), followed by a marked decline (p < 0.001). In contrast, dual CPs—mainly KPC combined with VIM or NDM—and single-MBL producers, particularly NDM, increased steadily, indicating a notable epidemiological shift. Resistance to aminoglycosides and tigecycline increased around 2021, followed by partial declines, whereas colistin resistance demonstrated a continuous upward trend throughout the study period. Despite phenotypic differences, overall mortality remained high, with no statistically significant differences between groups (p = 0.37), likely reflecting either the severity of patients’ clinical condition or inadequate empirical antibiotic therapy. Conclusions: This study highlights a dynamic evolution in CRKp epidemiology with decreasing KPC dominance and increasing prevalence of MBL- and dual CP strains. This transition, which became evident during and after the COVID-19 pandemic, underscores ongoing epidemiological adaptation and the urgent need for improved antimicrobial stewardship, rapid diagnostics, and broader access to effective therapies. Full article

Research increasingly identifies wild birds, particularly long-distance migratory species, as epidemiologically relevant hosts and vectors for tick-borne Borrelia species that pose risks to both avian and human health. This review contextualizes avian-associated Borrelia research historically and microbiologically, showing the role of avian hosts in the ecology of agents causing relapsing fever and Lyme borreliosis. We identify key publications that trace the evolution of Borrelia research—from early microscopic observations of spirochetes to the modern molecular and serological evidence. The review collects literature on the process by which Borrelia gained early scientific attention due to its characteristic morphology and elevated bloodstream concentrations during septicemic phases, which enabled early etiological links between the microbe and disease. It follows the recognition of avian spirochetosis caused by Borrelia anserina and charts the shift in focus after the discovery of Borrelia burgdorferi sensu lato (Subgen. novum recomm. Borreliella, Lyme-group Borrelia). Publications listed show that birds can transport infected human-parasitic ticks over long distances and, in certain bird species, selectively amplify Lyme-group Borrelia species, especially Borrelia garinii, which has the highest temperature tolerance and is thus potentially viable in avian hosts. The literature supports the role of birds in maintaining and disseminating Borrelia infections and infected ticks across continents. Full article

Background: Fluoroquinolone prophylaxis during autologous stem cell transplantation (aSCT) reduces the risk of fever but raises the risk of bloodstream infection (BSI) with fluoroquinolone-resistant Enterobacterales (FRE). We performed a prospective cohort study to detect the presence and potential gain or loss of colonic FRE colonization using serial sampling before and after aSCT in a uniform population of patients with a diagnosis of multiple myeloma. Methods: Eligible subjects underwent aSCT after conditioning with dose-intense melphalan, 200 mg/m². Peri-anal swabs were obtained before aSCT, upon hospital discharge, and 12–16 weeks after transplantation. Samples were cultured in tryptic soy broth supplemented with either ciprofloxacin or ceftriaxone with subsequent plating onto selective chromogenic agar designed to facilitate recovery and differentiation of Enterobacterales. Results: FRE colonization on pre-transplant sampling was detected for 23 of 117 subjects (19.7%) and 29 of 98 (29.6%) subjects at hospital discharge after a course of fluoroquinolone (116/117 subjects) prophylaxis (p < 0.001) and 28 of 92 (30.4%) subjects at 12–16 weeks. Including all three sampling time points, 48 of 117 subjects (41.0%) tested positive for FRE colonization. In total, 58 of the 90 FRE isolates (64.4%) from 48 subjects expressed extended-spectrum beta-lactamase (ESBL). Three FRE-colonized subjects developed FRE BSI. Bloodstream isolates for two subjects were identical to the organisms identified on pre-transplant sampling. Conclusions: We hypothesize that fluoroquinolone prophylaxis of subjects with undetected low levels of FRE colonization allows the expansion of the FRE population, placing subjects at risk of BSI with fluoroquinolone-resistant (and ESBL-expressing) Enterobacterales. Pre-transplant testing for FRE colonization permits patient-specific design of prophylactic and empiric antibiotic regimens. Full article

Background: Candida isolation is common in critically ill patients, but its clinical interpretation depends strongly on microbiological source, host factors, and clinical context. Bloodstream isolation, candiduria, respiratory tract isolation, surveillance cultures, catheter-tip cultures, and wound/skin cultures have different clinical implications. We aimed to evaluate clinical characteristics, microbiological sources, species distribution, antifungal treatment patterns, and outcomes among adult ICU patients with Candida-positive ICU cultures. Methods: This single-center retrospective observational cohort study was conducted in the medical intensive care unit of Marmara University Faculty of Medicine between 1 October 2022 and 5 September 2025. Adult ICU patients with at least one Candida-positive ICU culture were included. Non-Candida fungal isolates and duplicate patient-level records were excluded. The primary outcome was all-cause 28-day mortality. ICU mortality was defined as all-cause death during ICU stay. Source-stratified analyses and expanded multivariable logistic regression models were performed to evaluate factors associated with mortality. Results: A total of 349 adult ICU patients were included. Median age was 71 years [IQR, 62–82], and 185 patients were male (53.0%). Overall, 28-day mortality was 59.0% (206/349), and ICU mortality was 65.9% (230/349). Candida colonization was identified in 247 patients (70.8%), whereas Candida infection was identified in 102 patients (29.2%). The most common species were Candida albicans (48.4%), Candida glabrata (13.8%), and Candida auris (12.9%). The most frequent microbiological sources were urine (42.4%), lower respiratory tract samples (26.4%), and blood cultures (14.9%). Blood/sterile-site isolation was associated with higher ICU mortality than non-blood/non-sterile-site isolation (79.2% vs. 63.5%, p = 0.026), whereas the difference in 28-day mortality was not statistically significant (66.0% vs. 57.8%, p = 0.260). Antifungal treatment was more frequent among patients with blood/sterile-site isolation (94.3% vs. 16.9%, p < 0.001). In the expanded 28-day mortality model, lactate, NLR, and carbapenem exposure were independently associated with mortality. In the expanded ICU mortality model, lactate and CRRT/hemodialysis were independently associated with mortality. Candida score was not independently associated with either 28-day mortality or ICU mortality after broader adjustment. Conclusions:Candida-positive ICU cultures represent a heterogeneous clinical and microbiological spectrum. Source-specific interpretation is essential, particularly when distinguishing bloodstream or sterile-site isolation from non-sterile-site colonization. Candida score may reflect a higher-risk clinical phenotype, but it should not be interpreted as a stand-alone mortality prediction tool. Full article

Gram-positive infections are associated with significant morbidity and healthcare burden, often requiring prolonged intravenous therapy. Dalbavancin, a long-acting lipoglycopeptide, has emerged as a promising option beyond its approved indication for acute bacterial skin and skin structure infections (ABSSSI). A systematic review was conducted according to the PRISMA guidelines (PROSPERO: CRD420261296328). MEDLINE, Embase, CENTRAL, and Web of Science were searched from inception. Randomized controlled trials (RCTs) and observational studies evaluating dalbavancin in adult patients with Gram-positive infections were included. Outcomes of interest were clinical effectiveness, safety, and healthcare resource utilization. Risk of Bias was assessed using RoB 2 and the Newcastle–Ottawa Scale. Twenty-one studies were included. Randomized trials confirmed non-inferior efficacy of dalbavancin compared with standard therapy in ABSSSI. Observational studies demonstrated high clinical success rates across a range of infections, including osteo-articular infections, bloodstream infections, and infective endocarditis (IE), particularly in acute settings. Lower effectiveness was observed in biofilm-related infections without adequate source control. Dalbavancin was frequently used as sequential or consolidation therapy in complex patients. Its use was consistently associated with reduced length of hospital stay, facilitation of outpatient management, and potential cost savings. The safety profile was favorable, including in prolonged or multi-dose regimens. In conclusion, dalbavancin represents an effective and well-tolerated option for Gram-positive infections, with expanding evidence supporting its use in complex and off-label settings. Its pharmacokinetic profile enables simplified treatment strategies and improved healthcare resource utilization, although appropriate patient selection and source control remain essential. Full article

Background/Objectives: Eravacycline is a fluorocycline antibiotic increasingly used for drug-resistant or difficult-to-treat infections, including off-label indications, with limited real-world clinical data. This study aimed to characterize the effectiveness, safety, and overall risk-benefit profile of eravacycline using an adapted Desirability of Outcome Ranking (DOOR) framework. Methods: We conducted a retrospective, single-center observational study of adult patients who received ≥48 h of eravacycline at an academic medical center between May 2022 and October 2023. Clinical response was assessed at the end of therapy, alongside 30-day all-cause mortality. Treatment-emergent adverse events (TEAEs) were recorded and normalized per 100 eravacycline-days. An adapted DOOR framework integrated efficacy, toxicity and mortality into an ordinal composite outcome, with analyses stratified by pathogen and site of infection. Results: A total of 140 patients contributed 151 eravacycline courses. Intra-abdominal (41.7%) and lower respiratory tract infections (27.8%) were the most common indications. Treatment success was observed in 69.5% of courses, while 30-day all-cause mortality was 23.6%. TEAEs occurred in 52.3% of courses and frequently led to eravacycline discontinuation. Exposure-normalized TEAE rates were highest in shorter courses, with gastrointestinal intolerance predominating early, while hepatoxicity and coagulation abnormalities were more frequent with intermediate treatment durations. DOOR analysis demonstrated highly desirable outcomes in 48.3% of courses, with more favorable profiles observed in carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE) and nontuberculous mycobacteria (NTM) infections. Bloodstream infections were associated with less desirable outcomes. Conclusions: Eravacycline demonstrated meaningful real-world activity across complex infections but was limited by frequent toxicity. The DOOR framework provided a patient-centered context for organism- and site-specific risk-benefit assessment. Full article

Background: Streptococcus pneumoniae, also referred to as pneumococcus, is of immense public health significance. In particular, it causes severe invasive diseases among children. This has led to the recommendation of anti-pneumococcal prophylaxis, including the administration of penicillin and pneumococcal conjugate vaccines (PCVs), which have become available in about 90% of the countries in sub-Saharan Africa. Nonetheless, breakthrough disease still occurs. Also, PCVs can cause a shift in the distribution of pneumococcal serotypes, usually towards non-vaccine types. However, in many sub-Saharan African countries where PCVs have been introduced, there are hardly any comprehensive post-vaccination surveillance data on pneumococcus. Aim: To describe the post-vaccination epidemiology of invasive pneumococcal disease (IPD) in Ghana, including the prevalence, serotype distribution and antibiotic resistance. Methods: The study was cross-sectional and involved 14,597 patients recruited at the Korle Bu Teaching Hospital, Greater Accra Regional Hospital, Princess Marie Louise Children’s Hospital, Ho Regional Hospital, Eastern Regional Hospital, and Zonal Public Health and Reference Laboratory, Tamale. Specimens of cerebrospinal fluid (obtained by lumbar puncture) and blood were collected routinely from meningitis patients, while blood specimens were taken from pneumonia patients. These were cultured for S. pneumoniae following standard microbiological methods and subjected to antimicrobial susceptibility testing. The isolates were serotyped by the pneumotest latex agglutination kit, and the results confirmed by Quellung reaction, using serotype-specific antisera. Results: The overall prevalence of IPD was 0.66% (n = 97), varying across syndromes: bloodstream infections (0.53%, n = 38), meningitis (2.45%, n = 43), and pneumonia (0.28%, n = 16). The majority of the cases (56.70%, n = 55) occurred in the 11–20-year-old group. Ten pneumococcal serotypes were identified, with Serotype 1 being predominant (58.76%), followed by Serotypes 23B (11.34%), 33F (9.28%), and 12F (8.24%). Vaccine serotypes accounted for 81.44% of the isolates, while 18.56% were non-vaccine serotypes (23A, 23B, and 38). Antimicrobial resistance was highest against sulphamethoxazole-trimethoprim (52%), ampicillin (51%), and penicillin (46%). No resistance was observed against ciprofloxacin, levofloxacin, and vancomycin. The multidrug resistance proportion was 42.3% (n = 41). Conclusions: Even in the post-vaccination era, vaccine-type IPD remains a significant public health issue in Ghana. The observed serotype distribution and antimicrobial resistance patterns warrant sustained surveillance, more adaptive vaccination policies, and rigorous antibiotic stewardship to effectively mitigate IPD burden. Full article

Background/Objectives: Bloodstream infections (BSIs) are a major cause of morbidity and mortality, particularly when delays in pathogen identification hinder timely and targeted antimicrobial therapy. Rapid diagnostic tests (RDTs) accelerate microbiological identification, yet their clinical impact remains heterogeneous across different healthcare settings. This study aimed to evaluate the real-world effect of implementing FAST microbiology, a diagnostic workflow that integrates RDTs into conventional blood culture processing, on diagnostic timeliness, antimicrobial decision-making, and patient management in a hospital specializing in complex infectious diseases. Methods: We conducted a quasi-experimental study comparing non-FAST and FAST workflows over a 24-month period, including 166 adult patients with sepsis admitted to ICU and non-ICU units, accounting for 231 BSIs. Microbiological outcomes, treatment dynamics, time to targeted therapy, and key clinical endpoints were compared between non-FAST and FAST groups. Results: FAST microbiology significantly reduced the time to initiation of targeted therapy across clinical settings. No statistically significant differences were observed in hospital length of stay, overall mortality, or 28-day mortality between the two groups. Baseline clinical severity, age, and comorbidity burden remained the main determinants of clinical outcomes. Conclusions: These real-world findings support the integration of rapid diagnostics into existing antimicrobial stewardship frameworks by improving diagnostic timeliness and supporting earlier microbiologically guided therapeutic decisions. However, the results also highlight that accelerating diagnostics alone may not be sufficient to improve survival in critically ill patients with complex infectious diseases, where outcomes are predominantly driven by patient- and disease-related factors. Full article

Bloodstream infections (BSIs) are associated with substantial morbidity, mortality, and healthcare costs. Conventional diagnostics are limited by delayed results, often postponing appropriate antimicrobial therapy. This review aimed to evaluate the clinical and economic value of rapid microbiological diagnostics in BSI management. A state-of-the-art evidence synthesis was conducted using structured searches of PubMed/MEDLINE, Scopus, Web of Science, EconLit, and Google Scholar (2013–2025). Eligible studies included economic evaluations and clinical studies reporting downstream economic or resource-use outcomes. Screening and data extraction were performed by two reviewers, and findings were narratively synthesized. Fifty-nine studies were included. Rapid diagnostics consistently reduced time to pathogen identification and targeted therapy compared to conventional methods. Molecular platforms provided results within hours, while MALDI-TOF enabled identification within 30–60 min after culture positivity. Clinical benefits included earlier therapy optimization, reduced mortality, and shorter hospital stays, particularly when combined with antimicrobial stewardship programs (ASPs). Economic evaluations demonstrated improved cost-effectiveness, including reduced hospitalization, ICU utilization, and antimicrobial costs. MALDI-TOF with stewardship showed notable cost savings and improved outcomes. However, results varied depending on implementation context, infrastructure, and workflow integration. Rapid microbiological diagnostics offer significant clinical and economic benefits in BSI management, particularly when integrated with stewardship programs. Context-specific implementation is essential to maximize their value across healthcare systems. Full article