Clinical Impact of Rapid Molecular Diagnosis of Bloodstream Infections: A Randomized Controlled Trial
In brief
Rapid PCR shortens time to effective therapy by 41 hours
In a trial of 418 patients with positive blood cultures, adding BioFire BCID2 multiplex PCR cut the median time to the first effective antimicrobial change from about 65 to 23 hours, a reduction of roughly 41 hours. Persistent bloodstream infections fell nearly in half (5.7% vs 11.5%), while 30-day mortality and hospital stay were unchanged. The findings suggest faster pathogen ID can speed treatment adjustments, but survival benefit remains unproven.
- Journal
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Q1)
- Published
- 20 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Keun Ju Kim, Young Kyung Yoon, Jeong Yeon Kim, Min Ja Kim, Jang Wook Sohn, Myung Hyun Nam
- PMID
- 42619534
- DOI
- 10.1093/cid/ciag511
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 23 August 2026): Randomized trial, rapid molecular BSI diagnosis in ICU patients
- Picked for Microbiology (medical) (top studies of the week, 23 August 2026): RCT shows faster antimicrobial modification with BCID2
Abstract
BACKGROUND: Rapid identification of pathogens and antimicrobial resistance is important for optimizing therapies for bloodstream infections. We conducted a randomized controlled trial comparing standard of care (SOC) culture and phenotypic antimicrobial susceptibility testing with SOC plus BioFire BCID2 testing (Multiplex PCR arm). METHODS: Patients with positive blood cultures were randomized 1:1 to the SOC or multiplex PCR arm, both with antimicrobial stewardship. The primary outcome was the time from randomization to the first effective antimicrobial modification within 120 h. The secondary outcomes were persistent bloodstream infections, mortality, and length of hospital stay. RESULTS: Among 418 patients (208 SOC, 210 multiplex PCR), the median time to first effective antimicrobial modification was significantly shorter in the multiplex PCR arm (23.2 vs. 64.5 h; P < 0.001). This was consistent across gram-negative (30.5 vs. 77.1 h; P < 0.001), gram-positive (22.7 vs. 53.5 h; P = 0.001), and yeast infections (2.9 vs. 27.7 h; P < 0.001). The reduction was maintained regardless of laboratory hours (regular hours: 9.3 vs. 66.7 h; off-hours: 37.5 vs. 60.5 h; P < 0.001) and intensive care unit (ICU) status (ICU: 20.5 vs. 84.8 h; P < 0.001; non-ICU: 23.4 vs. 55.5 h; P < 0.001). The multiplex PCR arm showed a lower rate of persistent bloodstream infections (5.7% vs. 11.5%, P = 0.038). No significant differences were observed in 30-day mortality or length of stay. CONCLUSIONS: Rapid multiplex PCR shortened the time to effective antimicrobial modification in patients with bloodstream infections.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.