BACKGROUND Bloodstream infection (BSI) is a major public health burden worldwide, with high mortality. Patient outcome is critically influenced by delayed therapy, and fast and accurate pathogen diagnostics decisively improves the care of patients. During the past two decades major improvements have been made in the diagnostic performance of blood culture diagnostics through actions on pre-analysis and time to result. AIMS To review and discuss the literature for standard procedures and the progress in BSI pathogen diagnostics, and to propose a new mindset to reach an improved diagnostic workflow. SOURCES Scientific articles and reviews available through NCBI/Pubmed. CONTENT Blood culture performance relies largely on the quality of its pre-analytical phase that is improved with educational actions monitored by using key performance indicators, and external quality assessment. Advanced blood culture systems now provide tools for an automated estimation of bottle filling. These proved efficient to facilitate effective training for improving blood collection. On analytic aspects, rapid methods for pathogen identification, among which matrix-assisted laser desorption/ionization time of flight mass spectrometry dominates, and rapid antimicrobial susceptibility testing are reviewed. These technical developments call for improvements in all other steps, especially in pre- and post-analytic logistics to give the full reciprocation of these techniques on patient management. This aspect is summarized by the term 'microbiologistics', which covers all possible improvements in the logistic chain from sampling to report. IMPLICATIONS Progress in BSI pathogen diagnostics is based on a bundle approach that includes optimization of the pre-analytical parameters, rapid start of incubation, the use of rapid methods, re-organization (e.g. 24/7, transportation service) and a close involvement of antimicrobial stewardship teams. These developments lead to define a new standard for bloodstream infection diagnostics.

中文翻译：

---

血流感染-病原体诊断的标准和进展。

背景技术血流感染（BSI）是世界范围内的主要公共卫生负担，具有很高的死亡率。延迟治疗会严重影响患者的预后，而快速而准确的病原体诊断将决定性地改善对患者的护理。在过去的二十年中，通过对预分析的行动和得出结果的时间，血培养诊断的诊断性能有了重大改进。目的审查和讨论标准程序的文献以及BSI病原体诊断的进展，并提出新的思路以达到改进的诊断工作流程。来源可通过NCBI / Pubmed获得科学文章和评论。内容血液培养的表现很大程度上取决于其分析前阶段的质量，通过使用关键绩效指标来监控教育行为，可以提高其质量。和外部质量评估。先进的血液培养系统现在提供了自动估计瓶装量的工具。这些被证明对促进有效的训练以改善血液采集是有效的。在分析方面，回顾了快速的病原体鉴定方法，其中基质辅助的激光解吸/电离飞行时间质谱法占主导地位，以及快速的抗菌药敏试验。这些技术发展要求在所有其他步骤中进行改进，尤其是在分析前后的物流中，以使这些技术在患者管理方面得到充分的体现。“微生物学”一词概括了这一方面，涵盖了从采样到报告的物流链中所有可能的改进。含义BSI病原体诊断的进展基于捆绑方法，包括优化分析前参数，快速开始孵育，使用快速方法，重新组织（例如24/7，运输服务）以及密切参与抗菌药物管理团队。这些发展为血液感染诊断定义了新的标准。