Esse J, Krappmann AB, Honold K, Träger J, Valenza G, Bogdan C, Held J (2026)
Publication Type: Journal article
Publication year: 2026
Book Volume: 14
Pages Range: e0132826-
Journal Issue: 8
DOI: 10.1128/spectrum.01328-26
Direct identification (ID) and antimicrobial susceptibility testing (AST) of bacteria from positive blood cultures (BCs) are crucial for rapid optimization of therapy in sepsis. The FAST system purifies a Liquid Colony (LC) from BC broth within 25-35 min for downstream applications. We investigated the performance of the FAST system on BCs growing Gram-negative rods combined with mass spectrometry (MALDI-TOF-MS), the β-LACTA-test, and VITEK 2 AST from LC. VITEK 2 AST results were analyzed after 6 and 8 h, and their impact on empiric antibiotic therapy was examined. We included 119 BCs. MALDI-TOF-MS identified all pathogens correctly. The β-LACTA test detected hydrolyzation of third-generation cephalosporins (n = 16) within minutes (sensitivity 87.5%, specificity 98.7%). The categorical (99.3%) and essential agreement (99.2%) between VITEK 2 AST from LC and the standard laboratory procedure (VITEK 2 AST from short-term culture) were excellent. However, ampicillin/sulbactam, piperacillin/tazobactam, and moxifloxacin showed very major error rates of 7.3% (n = 3), 10.0% (n = 1) and 6.3% (n = 2), respectively. After 6 h of VITEK 2 incubation, the AST results of some antibiotics were frequently available (ampicillin/sulbactam = 94.5%, ciprofloxacin = 91.7%, cefotaxime = 83.5%), while others were not (piperacillin/tazobactam = 0%, meropenem = 0%). The median time for completion of VITEK 2 AST was 8 h 41 min. Empiric therapy was ineffective in 17% of patients (n = 16). The necessity of escalation was first discovered by ID, β-LACTA test and VITEK 2 AST in 2 (12.5%), 7 (43.8%), and 7 (43.8%) patients, respectively. In summary, the FAST system is suitable for use in routine diagnostics. VITEK 2 AST from LC provided same-day results for a substantial proportion of blood cultures that were positive at the start of the laboratory day.IMPORTANCERapid pathogen identification and antimicrobial susceptibility testing (AST) directly from positive blood cultures are essential to optimize antimicrobial therapy in sepsis. In this study, the FAST system enabled preparation of a Liquid Colony within 25-35 min and provided highly reliable downstream results for Gram-negative bloodstream infections. Combined with MALDI-TOF-MS, β-LACTA testing, and VITEK 2 AST, the workflow achieved excellent agreement with standard laboratory methods while substantially shortening time to actionable results. Same-day AST results were available for a considerable proportion of blood cultures, allowing earlier recognition of ineffective empiric therapy. Importantly, rapid resistance detection by β-LACTA testing and accelerated AST identified the need for escalation of therapy in most inadequately treated patients. These findings demonstrate that integration of the FAST system into routine microbiological diagnostics can support earlier targeted antimicrobial therapy and strengthen antimicrobial stewardship efforts in sepsis management.
APA:
Esse, J., Krappmann, A.B., Honold, K., Träger, J., Valenza, G., Bogdan, C., & Held, J. (2026). Performance of the Qvella FAST system with downstream application of MALDI-TOF-MS, VITEK 2, and β-LACTA test for same-day identification and antimicrobial susceptibility testing of Gram-negative rods directly from positive blood cultures. Microbiology Spectrum, 14(8), e0132826-. https://doi.org/10.1128/spectrum.01328-26
MLA:
Esse, Jan, et al. "Performance of the Qvella FAST system with downstream application of MALDI-TOF-MS, VITEK 2, and β-LACTA test for same-day identification and antimicrobial susceptibility testing of Gram-negative rods directly from positive blood cultures." Microbiology Spectrum 14.8 (2026): e0132826-.
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