Rapid identification and antimicrobial susceptibility testing of pathogenic microorganisms from positive blood cultures
Wenna Xu, Xiaomin Liu, Nansong Xu, Xiaohui Li, Fangqi Liu, Qianyan Li, Minqi Li, Zulu Ye, Xin Zheng
Abstract
Bloodstream infections (BSIs) are severe illnesses associated with high mortality. Delays in obtaining microbial culture results often hinder timely targeted antimicrobial therapy. Our study aimed to evaluate the feasibility of rapid pathogen identification (ID) and antimicrobial susceptibility testing (AST) in BSIs.
Introduction
Among severe diseases, bloodstream infections (BSIs) are one of the most common causes of death [1]. A survey revealed that the case-fatality rate of nosocomial BSI in Europe ranges from 12% to 32%, with more than 29,000 deaths per year [2].
Materials and methods
All patients admitted to Sun Yat-Sen University Cancer Center between 01/06/2022 and 31/12/2023 with positive BCs from aerobic culture bottles (FAs) or anaerobic culture bottles (FNs) according to the results of the BactAlert VIRTUO or BacTAlert 3D microbial detection system (bioMérieux, Marcy l’Etoile, France) were included in this study.
Results
A total of 210 positive BCs were studied, including 118 Gram-negative bacteria (GNB), 78 Gram-positive bacteria (GPB), and 14 fungi. Sample IDs, blood-culture bottle types, time-to-positivity, and microbial identification results obtained by both rapid and conventional methods for all samples have been compiled into a table, as shown in Supplementary File 1.
Discussion
Timely administration of appropriate antimicrobials constitutes a critical factor for lowering morbidity and mortality among patients with BSIs. Rapid, accurate pathogen ID and AST are therefore indispensable, particularly for pathogens outside the coverage of standard empirical antimicrobial regimens.
Conclusion
In this study, we established an optimized workflow for rapid pathogen identification and AST using positive BCs. Combining vacuum separation-gel blood collection tubes with MALDI-TOF MS enabled reliable identification of GNB (particularly Enterobacterales) within half an hour, with no requirement for specialized additional equipment or extra consumable costs.
Citation: Xu W, Liu X, Xu N, Li X, Liu F, Li Q, et al. (2026) Rapid identification and antimicrobial susceptibility testing of pathogenic microorganisms from positive blood cultures. PLoS One 21(9): e0358947. https://doi.org/10.1371/journal.pone.0358947
Editor: Dwij Raj Bhatta, Tribhuvan University, NEPAL
Received: November 24, 2025; Accepted: September 8, 2026; Published: September 23, 2026
Copyright: © 2026 Xu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: ***PA at Accept: Please request that authors make data publicly accessible at Accept. Please update DAS at Accept as well*** The data generated and analyzed during this study are under embargo in Zenodo and will be publicly available after the publication of this article. The dataset can be accessed via https://doi.org/10.5281/zenodo.20591168.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
