The impact of multicenter microbiology laboratory workflow optimization on antimicrobial susceptibility testing reporting time and outcomes of patients with bloodstream infection
In brief
A 10-hospital blood-culture overhaul cut susceptibility reporting by 19 hours
In 1,826 adults with bloodstream infections, an optimized blood-culture workflow reduced median time to final antibiotic susceptibility results from about 70 hours to 51 hours. The post-optimization group also had lower in-hospital mortality and costs, but no shorter stays or antibiotic courses; the retrospective comparison cannot establish that the workflow caused those clinical differences.
- Journal
- Frontiers in cellular and infection microbiology (Q1)
- Published
- 16 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Jing Shao, Shuhong Sun, Lijuan Liu, Jing Li, Renzhe Li, Haixin Dong, et al.
- PMID
- 42819223
- DOI
- 10.3389/fcimb.2026.1875923
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 7 October 2026): Lab workflow optimization improves AST turnaround and outcomes
Abstract
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 6-8 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 h, 11.0 h and 18.5 h, respectively, in the optimized group. The median AST TAT for major pathogens decreased from 70.26 h to 51.14 h. Patients in the post-optimization group exhibited lower all-cause in-hospital mortality (P = 0.002), lower total hospitalization costs (P = 0.003), and lower antimicrobial expenditure was observed after IPTW adjustment (P < 0.001). 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.
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.