Septicemia from bloodstream infections (BSI) is the second largest cause of inpatient mortality and the single most expensive condition for US hospitals to manage. There has been an explosive development of commercial diagnostic systems to accelerate the identification and antimicrobial susceptibility testing (AST) of causative pathogens. Despite adoption of advanced technologies like matrix-assisted laser desorption imaging–time-of-flight mass spectrometry and multiplex polymerase chain reaction for rapid identification, clinical impact has been variable, in part due to the persistent need for conventional AST as well as prescriber understanding of these rapidly evolving platforms. Newer technologies are expanding on rapid detection of genotypic determinants of resistance, but only recently has rapid phenotypic AST been available. Yet, improved outcomes with rapid diagnostic platforms are still most evident in conjunction with active antimicrobial stewardship. This review will outline key advancements in rapid diagnostics for BSI and the role of antimicrobial stewardship in this new era.

血液感染引起的败血病（BSI）是住院病人死亡的第二大原因，也是美国医院要处理的最昂贵的疾病。商业诊断系统的爆炸性发展是为了加速对致病性病原体的识别和抗菌药敏测试（AST）。尽管采用了先进的技术，例如基质辅助激光解吸成像-飞行时间质谱和多重聚合酶链反应来快速鉴定，但临床影响仍然存在差异，部分原因是对常规AST的持续需求以及对处方者的了解这些快速发展的平台中。快速检测耐药性的基因型决定簇的新技术正在扩展，但是直到最近才出现了快速表型AST。然而，结合积极的抗菌管理，使用快速诊断平台改善结局仍然最为明显。这篇综述将概述BSI快速诊断的主要进展以及在这个新时代中抗菌管理的作用。