{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:48Z","timestamp":1789535088031,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    Bloodstream infections (BSIs) are life-threatening disorders linked to substantial global mortality, and timely pathogen identification (ID) and antimicrobial susceptibility testing (AST) are indispensable for targeted clinical management. Blood culture (BC) remains the gold-standard diagnostic approach, but conventional workflows often lead to prolonged turnaround times (TAT) and delayed targeted therapy. This multicenter retrospective study aimed to evaluate the impact of the BC workflow optimization strategy in 10 tertiary hospitals in Shandong Province, China. The intervention included 24\/7 uninterrupted specimen processing, rapid MALDI-TOF MS ID after short incubation periods of 6\u20138 h with results reporting, and second-day MALDI-TOF MS ID post-BC positivity with results reporting. A total of 1, 826 adult BSI patients were enrolled, with 942 in the pre-optimization group and 884 in the post-optimization group. The primary outcomes were BC TAT metrics, while secondary outcomes included pathogen distribution, antibiotic use, clinical outcomes, and healthcare costs. Compared with the pre-optimization group, the time from blood collection to the reporting of Gram-stain, MALDI-TOF MS ID and final AST were reduced by 13.4\u00a0h, 11.0\u00a0h and 18.5\u00a0h, respectively, in the optimized group. The median AST TAT for major pathogens decreased from 70.26\u00a0h to 51.14\u00a0h. Patients in the post-optimization group exhibited lower all-cause in-hospital mortality (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.002), lower total hospitalization costs (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.003), and lower antimicrobial expenditure was observed after IPTW adjustment (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&amp;lt;\u00a00.001). No significant differences were observed in hospital length of stay, laboratory testing costs or total antibiotic duration. We further performed IPTW to eliminate baseline confounding bias and reliably evaluate the independent clinical and economic benefits of this optimization bundle. This large real-world multicenter study demonstrates that BC workflow optimization substantially improves diagnostic efficiency and reduces healthcare burden, offering a replicable, cost-saving blueprint for clinical microbiology laboratories in tiered hospital systems.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2026.1875923","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:34:13Z","timestamp":1789533253000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of multicenter microbiology laboratory workflow optimization on antimicrobial susceptibility testing reporting time and outcomes of patients with bloodstream infection"],"prefix":"10.3389","volume":"16","author":[{"given":"Jing","family":"Shao","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Linyi People\u2019s Hospital","place":["Linyi, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, The Affiliated People\u2019s Hospital of Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, The Afffliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzhe","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Jining No.1 People\u2019s Hospital","place":["Jining, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixin","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Affiliated Hospital of Jining Medical University","place":["Jining, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Qingdao Municipal Hospital","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guixia","family":"Li","sequence":"additional","affiliation":[{"name":"The Laboratory Department of Heze Municipal Hospital","place":["Heze, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunzhong","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Binzhou People\u2019s Hospital","place":["Binzhou, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maoli","family":"Yi","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Yantai Yuhuangding Hospital","place":["Yantai, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.1007\/s10096-024-04928-2","article-title":"The impact of optimizing microbial diagnosis processes on clinical and healthcare economic outcomes in hospitalized patients with bloodstream infections","volume":"43","author":"Ai","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2020.115219","article-title":"Advances in rapid diagnostics for bloodstream infections","volume":"99","author":"Briggs","year":"2021","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"B3","volume-title":"Principles and procedures for blood cultures; approved guideline. CLSI document M47","year":"2022"},{"key":"B4","volume-title":"M100-S32. Performance standards for antimicrobial susceptibility testing","year":"2022"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2024.107176","article-title":"Clinical and economic evaluation of blood culture whole process optimisation in critically ill adult patients with positive blood cultures","volume":"63","author":"Dai","year":"2024","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B6","doi-asserted-by":"publisher","first-page":"141","DOI":"10.36519\/idcm.2024.319","article-title":"Rapid bacterial ID from positive blood cultures by MALDI-TOF MS following short-term incubation on solid media","volume":"6","author":"Demir","year":"2024","journal-title":"Infect. Dis. Clin. Microbiol."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01005-21","article-title":"Blood culture utilization in the hospital setting: a call for diagnostic stewardship","volume":"60","author":"Fabre","year":"2022","journal-title":"J. Clin. Microbiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"i9","DOI":"10.1093\/jac\/dkae278","article-title":"Validation of short culture method for rapid bacterial ID of blood cultures via matrix-assisted laser desorption\/ionization time-of-flight mass spectrometry","volume":"79","author":"Fitts","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"B9","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1080\/21681805.2022.2123039","article-title":"Community-onset urosepsis: incidence and risk factors for 30-day mortality - a retrospective cohort study","volume":"56","author":"Holmbom","year":"2022","journal-title":"Scand. J. Urol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/s1473-3099(20)30477-1","article-title":"Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals","volume":"21","author":"Kadri","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1111\/j.1469-0691.2012.03965.x","article-title":"Benchmarking inappropriate empirical antibiotic treatment","volume":"19","author":"Kariv","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"B12","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1038\/s41586-024-07725-1","article-title":"Blood culture-free ultra-rapid antimicrobial susceptibility testing","volume":"632","author":"Kim","year":"2024","journal-title":"Nature"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1097\/01.ccm.0000217961.75225.e9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"Kumar","year":"2006","journal-title":"Crit. Care Med."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2016.00697","article-title":"How to optimize the use of blood cultures for the diagnosis of bloodstream infections? A state-of-the art","volume":"7","author":"Lamy","year":"2016","journal-title":"Front. Microbiol."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9040830","article-title":"Update on coagulase-negative staphylococci-what the clinician should know","volume":"9","author":"Michels","year":"2021","journal-title":"Microorganisms"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmmb.2024.100747","article-title":"Accuracy of various matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)-based rapid ID methods-as a tool to augment diagnostic stewardship in blood culture laboratory, South India","volume":"52","author":"Padhy","year":"2024","journal-title":"Indian J. Med. Microbiol."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01028-23","article-title":"Laboratory approaches to determining blood culture contamination rates: an ASM Laboratory Practices Subcommittee report","volume":"62","author":"Palavecino","year":"2024","journal-title":"J. Clin. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01972-25","article-title":"Clinical performance of the VITEK REVEAL fast antimicrobial susceptibility test within a real-world workflow for gram-negative bacteremia: comparison with QMAC-dRAST and conventional methods","volume":"14","author":"Park","year":"2026","journal-title":"Microbiol. Spectr."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01927-25","article-title":"Optimizing blood culture diagnostics through laboratory automation: reducing turnaround time and improving clinical outcomes","volume":"13","author":"Qin","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01850-24","article-title":"Comparative evaluation of BacT\/ALERT VIRTUO and BACTEC FX400 blood culture systems for the detection of bloodstream infections","volume":"13","author":"Qin","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1111\/aas.14045","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock in adults 2021 - endorsement by the Scandinavian society of anaesthesiology and intensive care medicine","volume":"66","author":"Rehn","year":"2022","journal-title":"Acta Anaesthesiol Scand."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01050-25","article-title":"Improving time-to-result: head-to-head comparison of three rapid AST systems for Gram-negative bacteremia, including the newly developed VITEK REVEAL","volume":"63","author":"Squitieri","year":"2025","journal-title":"J. Clin. Microbiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1093\/clind\/24.4.584","article-title":"The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults","volume":"24","author":"Weinstein","year":"1997","journal-title":"Clin. Infect. Dis."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.01103-21","article-title":"Direct rapid ID from positive blood cultures by MALDI-TOF MS: specific focus on turnaround times","volume":"9","author":"Zengin Canalp","year":"2021","journal-title":"Microbiol. Spectr."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1875923\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:34:17Z","timestamp":1789533257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1875923\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":24,"alternative-id":["10.3389\/fcimb.2026.1875923"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1875923","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1875923"}}