Impact of early microbiology laboratory activation on rapid diagnosis and antimicrobial optimization in a sepsis alert pathway
In brief
Early microbiology calls linked to 24-hour diagnosis in 60% vs 35%
In this prospective study of 327 adults with sepsis alerts, patients whose microbiology lab was called early were more likely to receive an etiological diagnosis within 24 hours: 60% versus 35%. They also had antimicrobial treatment narrowed about a day sooner, but mortality and other major outcomes did not differ; the single-center observational findings do not establish that calls caused these benefits.
- Journal
- Diagnostic microbiology and infectious disease (Q2)
- Published
- 29 October 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- A Álvarez-Uría, S de la Villa, A Estévez, A Burillo, M Sancho, M Ferris Villanueva, et al.
- PMID
- 42967404
- DOI
- 10.1016/j.diagmicrobio.2026.117717
Why clinicians should know about it
- Picked for Microbiology (medical) (top studies of the week, 8 November 2026): Sepsis diagnostics, microbiologist activation, and time to de-escalation
Abstract
INTRODUCTION: Rapid microbiological diagnosis is important in sepsis, but the contribution of early microbiology laboratory activation (EMLA) within sepsis alert pathways is unclear. METHODS: We prospectively included consecutive adults with sepsis alert activation at a tertiary-care hospital between November 2022 and June 2023. EMLA was defined as direct telephone notification of the on-call microbiologist after sepsis alert activation. The primary outcome was etiological microbiological diagnosis within 24 hours. Secondary outcomes included rapid diagnostic techniques, antimicrobial de-escalation and time to de-escalation. Multivariable logistic regression assessed the association between EMLA and early diagnosis, adjusting for Charlson Comorbidity Index, septic shock, clinical service, and infection focus. RESULTS: Among 327 patients, an etiological diagnosis was established in 209 (63.9%); EMLA was documented in 213 (65.1%). Diagnosis within 24 hours was achieved in 127/213 (59.6%) patients with EMLA versus 40/114 (35.1%) without EMLA (p < 0.001). EMLA remained independently associated with early diagnosis (adjusted OR 2.99, 95% CI 1.80-4.98; p < 0.001). Rapid diagnostic techniques were used more frequently with EMLA (54.5% vs 43.0%, p = 0.045). De-escalation occurred in 171 patients (52.3%) and was performed earlier with EMLA (median 3 [IQR 2-4]. vs 4 [IQR 3-5]. days, p = 0.030). DOT, mortality, ICU admission, and hospital length of stay did not differ significantly. CONCLUSIONS: EMLA was independently associated with earlier microbiological diagnosis and antimicrobial de-escalation. These findings suggest that direct clinician-microbiologist communication may therefore be an important organizational component of diagnostic stewardship in sepsis.
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.