{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:33:38Z","timestamp":1789576418431,"version":"build-2803163510"},"reference-count":38,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["PE00000007, INF-ACT"],"award-info":[{"award-number":["PE00000007, INF-ACT"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2025,11,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Early antimicrobial susceptibility testing (AST) in Gram-negative (GN) bloodstream infections is critical to guide appropriate therapy. This study evaluated three rapid AST (RAST) systems\u2014VITEK REVEAL, direct-from-blood-culture VITEK 2 (VITEK 2-RAST), and EUCAST disk diffusion (DD-RAST)\u2014using 220 prospectively collected GN-positive blood cultures (GN-PBCs). A total of 18 GN species were tested, including\n                      <jats:italic toggle=\"yes\">Enterobacterales<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Acinetobacter baumannii<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      , against 25 antibiotics, four of which were next-generation \u03b2-lactam\/\u03b2-lactamase inhibitor (BL\/BLI) antibiotics. Reference broth microdilution was used for comparison. The VITEK REVEAL assay showed 97.1% essential agreement (EA), \u22127.7 bias, and 98.3% categorical agreement (CA) across 3,603 organism\/antibiotic combinations. The VITEK 2-RAST assay showed 96.2% EA, \u221210.4 bias, and 98.4% CA across 3,941 combinations. The DD-RAST assay showed 98.2% CA across 2,388 combinations. Among 164 GN-PBCs tested with all three assays, EA rates were 97.5% for VITEK REVEAL and 96.3% for VITEK 2-RAST, with bias values of \u22127.1 and \u22126.9, respectively. Across all three assays, the CA rate was \u226598.2%, and very major error (VME) rates were \u22641.8%. Mean time-to-result (TTR) was significantly shorter with VITEK REVEAL (6 h 32 min) compared to VITEK 2-RAST (13 h 51 min) and the fixed 8 h of DD-RAST. In resistant organisms, VITEK REVEAL produced significantly faster results than in susceptible or intermediate ones, including BL\/BLI antibiotics.\n                      <jats:italic toggle=\"yes\">A. baumannii<\/jats:italic>\n                      yielded the shortest TTR, with no observed VME. These results support the use of RAST directly on GN-PBCs, with VITEK REVEAL emerging as a particularly promising option for rapid and accurate testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>This study is the first to conduct a direct comparison of three rapid antimicrobial susceptibility testing (RAST) systems\u2014VITEK REVEAL, VITEK 2-RAST, and DD-RAST\u2014on a large, prospectively collected cohort of Gram-negative-positive blood cultures (GN-PBCs). The data offer valuable insights for laboratories evaluating RAST implementation, especially in EUCAST-based contexts. Among the systems tested, VITEK REVEAL stood out for its combination of rapid turnaround and high accuracy, including for antibiotic-resistant organisms and \u03b2-lactam\/\u03b2-lactamase inhibitor (BL\/BLI) antibiotics. These findings underscore the potential of RAST systems to deliver timely and reliable susceptibility results directly from GN-PBCs, thereby supporting more effective antimicrobial stewardship and clinical decision-making. However, the real-world impact will also depend on how well these systems integrate into routine workflows, as seamless implementation can directly affect time-to-result (TTR)\u2014an essential element in optimizing the management of GN-bloodstream infection (BSI).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/jcm.01050-25","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:00:35Z","timestamp":1760014835000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":10,"title":["Improving time-to-result: head-to-head comparison of three rapid AST systems for Gram-negative bacteremia, including the newly developed VITEK REVEAL"],"prefix":"10.1128","volume":"63","author":[{"given":"Damiano","family":"Squitieri","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Menchinelli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Magr\u00ec","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"D\u2019Inzeo","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]},{"name":"Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Fiori","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Cacaci","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9780-7059","authenticated-orcid":true,"given":"Maurizio","family":"Sanguinetti","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]},{"name":"Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"De Angelis","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]},{"name":"Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1663-7546","authenticated-orcid":true,"given":"Brunella","family":"Posteraro","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Universit\u00e0 Cattolica del Sacro Cuore","place":["Rome, Italy"]},{"name":"Unit\u00e0 Operativa \u201cMedicina di Precisione in Microbiologia Clinica\u201d, Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.49353"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.03.087"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181cc4824"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw402"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06944-2"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae282"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-020-0327-x"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11060705"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00098-22"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae219"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00692-24"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz548"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaa333"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky532"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaa554"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000001074"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf165"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02590-15"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13111058"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/biot.201700750"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mimet.2024.107003"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac347"},{"key":"e_1_3_5_24_2","unstructured":"EUCAST RAST Method v 4.0. 2023. Methodology \u2013 EUCAST Rapid Antimicrobial Susceptibility Testing (RAST) Directly from Positive Blood Culture Bottles. Available from: https:\/\/www.eucast.org\/rapid-ast-in-bloodcultures\/methods"},{"key":"e_1_3_5_25_2","volume-title":"Susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices\u2014Part 1: broth micro-dilution reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases","author":"ISO 20776-1","year":"2019","unstructured":"ISO 20776-1. 2019. Susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices\u2014Part 1: broth micro-dilution reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases. The International Organization for Standardization, Geneva, Switzerland."},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-018-0342-0"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-019-0480-z"},{"key":"e_1_3_5_28_2","unstructured":"EUCAST. 2024. Breakpoint Tables for Interpretation of MICs and Zone Diameters Version 14.0. Available from: http:\/\/www.eucast.org"},{"key":"e_1_3_5_29_2","unstructured":"EUCAST. 2024. Zone diameter Breakpoint Tables for rapid antimicrobial susceptibility testing (RAST) directly from blood culture bottles. Version 7.0. Available from: http:\/\/www.eucast.org"},{"key":"e_1_3_5_30_2","first-page":"20776","volume-title":"Clinical laboratory testing and in vitro diagnostic test systems\u2014 susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices","author":"ISO 20776-2:2021","year":"2021","unstructured":"ISO 20776-2:2021. 2021. Clinical laboratory testing and in vitro diagnostic test systems\u2014 susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices, p 20776. The International Organization for Standardization, Geneva, Switzerland."},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2024.06.028"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(23)00374-9"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2022.10.018"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.04.025"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab449"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkae280"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-48233-0"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.00221"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00420-19"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.01050-25","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.01050-25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T14:02:02Z","timestamp":1762956122000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/jcm.01050-25"}},"subtitle":[],"editor":[{"given":"Patricia J.","family":"Simner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":38,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,12]]}},"alternative-id":["10.1128\/jcm.01050-25"],"URL":"https:\/\/doi.org\/10.1128\/jcm.01050-25","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]},"assertion":[{"value":"2025-07-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e01050-25"}}