Table 1.
Study Characteristics
| Author, y | Country | Study Design | Patients | BSI Type | Group | Conventional Systems | RDT | Outcomes | Sample Size | Ref | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BC | BC + ASP | RDT | RDT + ASP | TOT | LOS | Mort | |||||||||
| AlQahtani, 2021 | U.S. | Quasi-exp | Adults | S. aureus | ✓ | ✓ | VITEK-2 | Xpert MRSA/SA BC assay | Yes | Yes | Yes | 25/14 | [23] | ||
| Alvarez, 2012 | Spain | Quasi-exp | ICU | GP/GN/Y | ✓ | ✓ | Conventional culture methods | LightCycler SeptiFast | No | Yes | Yes | 54/48 | [24] | ||
| Antworth, 2013 | U.S. | Quasi-exp | Adults and children | Candida | ✓ | ✓ | VITEK-2 | NA | No | Yes | No | 37/41 | [25] | ||
| Avdic, 2017 | U.S. | Quasi-exp | Adults | GP | ✓ | ✓ | NA | Verigene GP-BC | Yes | Yes | Yes | 136/137 | [26] | ||
| Bandy, 2023 | U.S. | Quasi-exp | Adults | VRE | ✓ | ✓ | VITEK-2 | Verigene GP-BC | Yes | Yes | Yes | 50/54 | [27] | ||
| Banerjee, 2015 | U.S. | RCT | Adults and children | GP/GN/Y | ✓ | ✓ | ✓ | MALDI-TOF MS, PBP2 immuno-chromatographic test for MRSA | BCID | No | Yes | Yes | 207/198/212 | [28] | |
| Banerjee, 2021 | U.S. | RCT | … | GN | ✓ | ✓ | MALDI-TOF MS, BMD, agar dilution | Accelerate Pheno Test | No | Yes | Yes | 22/222 | [29] | ||
| Bauer, 2010 | U.S. | Quasi-exp | Adults | S. aureus | ✓ | ✓ | MicroScan WalkAway System, cefoxitin disk testing | Xpert MRSA/SA BC assay | No | Yes | Yes | 74/82 | [30] | ||
| Beal, 2015 | U.S. | Quasi-exp | … | GP | ✓ | ✓ | Conventional culture methods, VITEK-2 | Verigene GP-BC | Yes | Yes | Yes | 80/67 | [31] | ||
| Beganovic, 2017 | U.S. | Quasi-exp | Adults and children | GP/GN | ✓ | ✓ | MALDI-TOF MS | NA | Yes | Yes | Yes | 126/126 | [32] | ||
| Benoist, 2018 | France | Quasi-exp | Adults and children | Candida | ✓ | ✓ | MALDI-TOF MS, E-test | NA | No | No | Yes | 33/37 | [33] | ||
| Ben-Zvi, 2019 | Israel | Quasi-exp | Adults | S. aureus | ✓ | ✓ | Conventional culture methods, chromogenic test, disk-diffusion, E-test | Xpert MRSA/SA BC assay | No | Yes | Yes | 125/129 | [34] | ||
| Beuving, 2015 | The NLD | RCT | Adults | GP/GN | ✓ | ✓ | BD Phoenix System | Multiplex PCR + semi-molecular AST | Yes | Yes | Yes | 109/114 | [35] | ||
| Bhat, 2016 | India | RCT | NICU | GP/GN | ✓ | ✓ | VITEK-2 | Multiplex PCR | No | Yes | Yes | 183/185 | [36] | ||
| Bhavsar, 2018 | U.S. | Quasi-exp | Children | GP/GN | ✓ | ✓ | VITEK-2, API Identification System | MALDI-TOF MS | No | Yes | Yes | 210/137 | [37] | ||
| Bouza, 2004 | Spain | RCT | … | GP/GN/Y | ✓ | ✓ | Conventional culture methods, BMD | NA | No | No | Yes | 208/89 | [38] | ||
| Bowman, 2021 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | Conventional culture methods | Verigene GN-BC | Yes | Yes | No | 77/80 | [39] | ||
| Box, 2015 | U.S. | Quasi-exp | Adults | GP | ✓ | ✓ | BD Phoenix System | Verigene GP-BC | No | Yes | Yes | 103/64 | [40] | ||
| Brock, 2019 | U.S. | Quasi-exp | Adults | S. aureus | ✓ | ✓ | Conventional culture methods | NA | No | Yes | No | 243/259 | [41] | ||
| Brosh-Nissimov, 2023 | Israel | Quasi-exp | … | GN | ✓ | ✓ | MALDI-TOF MS, VITEK-2 | Accelerate Pheno Test | No | Yes | Yes | 46/57 | [42] | ||
| Bukowski, 2018 | U.S. | Quasi-exp | Adults | S. aureus and CONS | ✓ | ✓ | VITEK-2, latex agglutination test, PBP2 immuno-chromatographic test for MRSA | Xpert MRSA/SA BC assay | Yes | Yes | Yes | 143/109 | [43] | ||
| Buss, 2018 | U.S. | Quasi-exp | Oncology | GP/GN/Y | ✓ | ✓ | ✓ | MALDI-TOF MS, BD Phoenix System | BCID | Yes | No | Yes | 52/43 | [44] | |
| Cairns, 2016 | Australia | RCT | Adults | GP/GN | ✓ | ✓ | MALDI-TOF MS | NA | Yes | No | Yes | 81/79 | [45] | ||
| Campos, 2022 | Brazil | Quasi-exp | ICU | GN | ✓ | ✓ | MALDI-TOF MS, VITEK-2, E-test, disk diffusion, BMD | MALDI-TOF MS + Gen Multi Sepsis Flow Chip | No | Yes | Yes | 114/102 | [46] | ||
| Chiasson, 2022 | U.S. | Quasi-exp | Adults | GP/GN/Y | ✓ | ✓ | Conventional culture methods and MicroScan WalkAway System | BCID | Yes | Yes | Yes | 82/98 | [47] | ||
| Claeys, 2020 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | ✓ | VITEK-2 | Verigene GN-BC | Yes | Yes | Yes | 237/308/287 | [48] | |
| Cosgrove, 2016 | U.S. | RCT | Adults | Enterococci | ✓ | ✓ | MALDI-TOF MS, BD Phoenix System | E. faecalis/OE PNA-FISH | Yes | Yes | Yes | 79/77 | [49] | ||
| Dare, 2021 | U.S. | Quasi-exp | Adults | GP/GN/Y | ✓ | ✓ | MALDI-TOF MS, VITEK-2, PBP2A latex agglutination test for MRSA | Accelerate PhenoTest | Yes | Yes | Yes | 188/155 | [50] | ||
| Dow, 2022 | Canada | Quasi-exp | … | GP/GN/Y | ✓ | ✓ | Conventional culture methods, VITEK-2 | NA | No | Yes | Yes | 226/195 | [51] | ||
| Dwriega, 2019a | U.S. | Quasi-exp | Children | S. aureus | ✓ | ✓ | MALDI-TOF MS, VITEK-2, E-test | S. aureus/CNS PNA-FISH + Xpert MRSA/SA BC assay | Yes | Yes | No | 50/32 | [52] | ||
| Dwriega, 2019b | U.S. | Quasi-exp | Children | CoNS | ✓ | ✓ | MALDI-TOF MS, VITEK-2, E-test | S. aureus/CNS Quick FISH | No | Yes | No | 152/59 | [53] | ||
| Emonet, 2016 | Switzerland | RCT | Adults | S. aureus & CONS | ✓ | ✓ | MALDI-TOF MS, disk diffusion test | real-time PCR | Yes | Yes | Yes | 41/48 | [54] | ||
| Erickson, 2019 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | NA | BCID | No | Yes | Yes | 51/86 | [55] | ||
| Faugno, 2021 | Australia | Quasi-exp | Children | GP/GN/Y | ✓ | ✓ | Conventional culture methods, disc susceptibility testing, VITEK-2 |
MALDI-TOF MS from positive BC + GeneXpert MRSA/SA | Yes | Yes | Yes | 129/126 | [56] | ||
| Felsenstein, 2016 | U.S. | Quasi-exp | Children | GP | ✓ | ✓ | Conventional culture methods, VITEK-2, E-test + cefoxitin disk diffusion | Verigene GP-BC | Yes | Yes | Yes | 194/189 | [57] | ||
| Forrest 2008 | U.S. | Quasi-exp | Adults | Enterococci | ✓ | ✓ | Conventional culture methods, catalase detection, VITEK-2, disc diffusion | E. faecalis/OE PNA-FISH | No | No | Yes | 132/95 | [58] | ||
| Frye 2012 | U.S. | Quasi-exp | Adults | S. aureus and CoNS | ✓ | ✓ | Conventional culture methods, catalase and latex coagulase test, PBP2 latex agglutination test for MRSA | BD GeneOhm StaphSR PCR assay | No | Yes | Yes | 134/110 | [59] | ||
| Gawrys, 2020 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | VITEK-2 | Verigene GN-BC | Yes | Yes | Yes | 68/73 | [60] | ||
| Goshorn, 2023 | U.S. | Quasi-exp | … | CoNS | ✓ | ✓ | ✓ | MALDI-TOF MS, Microscan WalkAway system | ePlex System | No | Yes | Yes | 65/60/57 | [61] | |
| Gritte, 2021 | U.S. | Quasi-exp | Adults | S. aureus and CONS | ✓ | ✓ | VITEK-2 | GeneXpert MRSA/SA BC | Yes | Yes | Yes | 113/73 | [62] | ||
| Heil, 2012 | U.S. | Quasi-exp | … | Candida | ✓ | ✓ | CHROMagar and API 20C | Candida PNA-FISH | Yes | Yes | Yes | 61/21 | [63] | ||
| Hogan, 2020 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | Microscan WalkAway system | MALDI-TOF MS + VITEK-2 on pos BC | No | Yes | Yes | 336/335 | [64] | ||
| Karpen, 2023 | U.S. | Quasi-exp | Adults, noncritically ill | GP/GN | ✓ | ✓ | NA | Verigene GP-BC and GN-BC | No | Yes | Yes | 100/100 | [65] | ||
| Koh, 2018 | Ireland | Quasi-exp | NICU | S. aureus and CONS | ✓ | ✓ | VITEK-2 | GeneXpert MRSA/SA | No | Yes | No | 42/45 | [66] | ||
| Kremer, 2023 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | MALDI-TOF MS | BCID | Yes | Yes | Yes | 120/120 | [67] | ||
| Lockwood, 2015 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | Conventional culture methods | MALDI-TOF MS and BD-Phoenix system on positive BC | Yes | Yes | Yes | 149/241 | [68] | ||
| Lopez-Pintor, 2021 | Spain | Quasi-exp | … | GN | ✓ | ✓ | MALDI-TOF MS, semiautomatic AST | MALDI-TOF MS and semiautomatic AST on positive BC | No | Yes | Yes | 125/188 | [69] | ||
| MacGowan, 2020 | UK | RCT | Adults | GP/GN/Y | ✓ | ✓ | Conventional biochemical culture methods | MALDI-TOF MS on positive BC | No | Yes | Yes | 2810/2740 | [70] | ||
| MacVane, 2016 | U.S. | Quasi-exp | Adults | GP/GN | ✓ | ✓ | ✓ | Traditional phenotypic methods, MicroScan WalkAway System | BCID + direct coagulase test for S. aureus | No | Yes | Yes | 115/104/145 | [71] | |
| Magarifuchi, 2018 | Japan | Quasi-exp | … | GP/GN | ✓ | ✓ | Conventional culture methods, BMD | MALDI-TOF MS + direct disk diffusion | No | No | Yes | 129/119 | [72] | ||
| Mahrous, 2020 | Saudi Arabia | Quasi-exp | Adults | GP/GN | ✓ | ✓ | VITEK-2 | Verigene GP-BC and GN-BC | No | Yes | Yes | 164/148 | [73] | ||
| Malcolmson, 2017 | Canada | Quasi-exp | Children | GP/GN/Y | ✓ | ✓ | Conventional culture methods, BD Phoenix System, E-test, disc-diffusion | MALDI-TOF MS on positive BC | Yes | Yes | Yes | 100/121 | [74] | ||
| Mancini, 2014 | Italy | Quasi-exp | Hematology | GP/GN/Y | ✓ | ✓ | VITEK-2 | LightCycler SeptiFast | No | No | Yes | 101/101 | [75] | ||
| Mazzillo-Vega, 2020 | Spain | Quasi-exp | Children | GP/GN/Y | ✓ | ✓ | BD Phoenix System | BCID | Yes | No | No | 50/50 | [76] | ||
| McCarthy, 2022 | U.S. | Quasi-exp | … | GP/GN | ✓ | ✓ | NA | Verigene GP-BC and GN-BC | No | Yes | Yes | 67/57 | [77] | ||
| Messacar, 2017 | U.S. | Quasi-exp | Children | GP/GN/Y | ✓ | ✓ | Microscan panel, chromogenic methods, API20. PBP2 latex agglutination for MRSA | BCID | Yes | Yes | Yes | 200/100 | [78] | ||
| Mohayya, 2023 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | MALDI-TOF MS, BD Phoenix System | Acelerate Pheno Test | No | Yes | Yes | 93/131 | [79] | ||
| Moni, 2022 | India | Quasi-exp | Adults | Candida | ✓ | ✓ | VITEK-2 | NA | No | No | Yes | 103/72 | [80] | ||
| Nakagawa, 2018 | U.S. | Quasi-exp | Adults | VRE | ✓ | ✓ | Sensititre | Verigene GP-BC, direct disk diffusion | Yes | Yes | Yes | 44/20 | [81] | ||
| Nasef, 2020 | UAE | Quasi-exp | Adults | GP/GN/Y | ✓ | ✓ | VITEK-2 | BCID | Yes | Yes | Yes | 86/120 | [82] | ||
| Niwa, 2018 | Japan | Quasi-exp | … | GP/GN/Y | ✓ | ✓ | Automated system for identification and AST (RAISUS system) | MALDI-TOF MS on positive BC | Yes | Yes | Yes | 180/186 | [83] | ||
| Ohashi, 2018 | Japan | Quasi-exp | Adults | MRSA | ✓ | ✓ | Conventional culture methods | NA | No | Yes | Yes | 43/21 | [84] | ||
| Osthoff, 2017 | Switzerland | Quasi-exp | Adults | GP/GN/Y | ✓ | ✓ | Conventional culture methods, MALDI-TOF MS, VITEK-2, E-test | MALDI-TOF MS on positive BC | No | Yes | Yes | 200/168 | [85] | ||
| Page, 2017 | Ireland | Quasi-exp | Obstetric | S. aureus & CONS | ✓ | ✓ | VITEK-2 | Xpert MRSA/SA BC assay | No | Yes | No | 25/15 | [86] | ||
| Pardo, 2016 | U.S. | Quasi-exp | Adults | GP/GN | ✓ | ✓ | VITEK-2. For yeasts: API ID strips, Sensititre YeastOne | BCID | No | Yes | Yes | 252/84 | [87] | ||
| Patch, 2018 | U.S. | Quasi-exp | Adults | Candida | ✓ | ✓ | Conventional culture methods | T2Candida | Yes | Yes | Yes | 19/20 | [88] | ||
| Perez, 2014 | U.S. | Quasi-exp | Adults | GN | ✓ | ✓ | BD Phoenix system | MALDI-TOF MS on positive BC | Yes | Yes | Yes | 157/112 | [89] | ||
| Perez-Lazo, 2023 | Peru | Quasi-exp | Hematology | GP/GN/Y | ✓ | ✓ | Conventional culture methods, VITEK-2. | BCID2 | No | Yes | Yes | 62/31 | [90] | ||
| Pettit, 2019 | U.S. | Quasi-exp | Adults | Candida | ✓ | ✓ | MALDI-TOF MS | NA | No | Yes | Yes | 42/42 | [91] | ||
| Puckett, 2021 | U.S. | Quasi-exp | Children | GP/GN/Y | ✓ | ✓ | MALDI-TOF MS, BD Phoenix system; E-test, disk diffusion | MALDI-TOF MS on positive BC | Yes | No | No | 65/66 | [92] | ||
| Reed, 2014 | U.S. | Quasi-exp | Adults | Candida | ✓ | ✓ | Conventional culture methods | NA | No | Yes | Yes | 85/88 | [93] | ||
| Rivard, 2017 | U.S. | Quasi-exp | … | GN | ✓ | ✓ | MALDI-TOF MS, VITEK-2, disk diffusion, Sensititre, Etest | Verigene GN-BC | No | Yes | Yes | 456/421 | [94] | ||
| Rodrigues, 2019 | Brazil | RCT | Adults | GP/GN/Y | ✓ | ✓ | MALDI-TOF MS, VITEK-2, disk diffusion and or MIC detection according to the laboratory protocol. | LightCycler SeptiFast | Yes | Yes | Yes | 100/100 | [95] | ||
| Romero-Gomez, 2017 | Spain | Quasi-exp | Adult and children | S. aureus | ✓ | ✓ | Conventional culture methods, VITEK-2 | MALDI-TOF MS on positive BC + PCR | No | Yes | No | 133/94 | [96] | ||
| Rosa, 2018 | U. S. | Quasi-exp | … | S. aureus | ✓ | ✓ | Latex agglutination test, VITEK-2 | NA | No | No | Yes | 132/117 | [97] | ||
| Roshdy, 2015 | U.S. | Quasi-exp | … | GP | ✓ | ✓ | Conventional culture methods, MALDI-TOF MS, VITEK-2, disk diffusion, Etests | Verigene GP-BC | Yes | No | No | 65/74 | [98] | ||
| Sango, 2013 | U.S. | Quasi-exp | … | Enterococci | ✓ | ✓ | Conventional culture methods, VITEK-2 | Verigene GP-BC | Yes | Yes | Yes | 46/28 | [99] | ||
| Schuman, 2021 | Germany | Quasi-exp | ICU | GP/GN/Y | ✓ | ✓ | MALDI-TOF MS, BD Phoenix System, disc diffusion | BCID | Yes | No | No | 149/178 | [100] | ||
| Senda, 2011 | Japan | Quasi-exp | … | MRSA | ✓ | ✓ | Conventional culture methods | MALDI-TOF MS on positive BC | No | No | Yes | 40/25 | [101] | ||
| Senok, 2023 | UAE | Quasi-exp | ICU | GP/GN/Y | ✓ | ✓ | MALDI-TOF MS, VITEK-2 | BCID2 | No | No | Yes | 99/86 | [102] | ||
| Smith, 2018 | U.S. | Quasi-exp | Adults | S. aureus | ✓ | ✓ | NA | NA | Yes | No | Yes | 86/172 | [103] | ||
| Tritle, 2022 | U.S. | Quasi-exp | Adults | GP/GN/Y | ✓ | ✓ | Microscan Walkaway system with ESBL confirmatory testing | BCID | Yes | Yes | Yes | 94/172 | [104] | ||
| Tseng, 2018 | U.S. | Quasi-exp | Adults | GP/GN/Y | ✓ | ✓ | MALDI-TOF MS, BD Phoenix System | BCID | No | No | Yes | 103/100 | [105] | ||
| Turner, 2017 | U.S. | Quasi-exp | Adults | S. aureus | ✓ | ✓ | VITEK-2; E-test (for daptomycin) | Xpert MRSA/SA BC assay | Yes | Yes | Yes | 343/130 | [106] | ||
| Walker, 2016 | U.S. | Quasi-exp | Cancer | GN | ✓ | ✓ | VITEK-2, e-test (ESBL), modified Hodge test (carbapenemases) | Verigene GN-BC | Yes | Yes | Yes | 98/97 | [107] | ||
| Welch, 2020 | U.S. | Quasi-exp | Children | S. aureus | ✓ | ✓ | MicroScan WalkAway system | BCID | Yes | Yes | Yes | 32/36 | [108] | ||
| Wenzler, 2017 | U.S. | Quasi-exp | Adults | S. aureus | ✓ | ✓ | NA | Verigene GP-BC | No | Yes | Yes | 45/39 | [109] | ||
| Yamada, 2023 | Japan | Quasi-exp | … | S. aureus and CONS | ✓ | ✓ | MicroScan WalkAway system | Xpert MRSA/SA BC assay | Yes | Yes | Yes | 98/97 | [110] | ||
Abbreviations: ASP, antimicrobial stewardship program; BSI, bloodstream infection; BC, blood culture; BCID, BioFire FilmArray blood culture identification panel; CNS, central nervous system; CoNS, coagulase negative Staphylococcus spp.; GN, Gram-negative; GP, Gram-positive; ICU, intensive care unit; LOS, length of stay; MALDI-TOF MS, matrix-assisted laser desorption ionization–time-of-flight mass spectrometry; Mort, mortality; MRSA/SA, methicillin-resistant S. aureus/S. aureus; NA, not applicable; NICU, neonatal intensive care unit; NLD, Netherlands; OE, other enterococci; PBP2, penicillin-binding protein; PCR, polymerase chain reaction; PNA-FISH, peptide nucleic acid fluorescent in situ hybridization; quasi-exp, quasi-experimental; RCT, randomized controlled trial; RDT, rapid diagnostic test; TOT, time to optimal therapy; UAE, United Arab Emirates; VRE, vancomycin-resistant Enterococcus spp.; Y, yeast.