PhD Scientific Days 2025

Poster Session III. - K: Theoretical and Translational Medicine

Diagnostic Accuracy of Rapid Molecular Assays Versus Blood Culture for the Detection of Bloodstream Infections: A Systematic Review and Meta-Analysis

Name of the presenter

Rapszky Gabriella Anna

Institute/workplace of the presenter

Demartment of Emergency Medicine, Semmelweis Univeristy

Authors

Gabriella Anna Rapszky¹, Uyen Nguyen Do To², Veronika Eszter Kiss¹, Tamás Kói³, Anna Walter⁴, Dorottya Gergő⁵, Fanni Adél Meznerics⁶, Márton Rakovics⁷, Szilárd Váncsa⁸, Lajos Vince Kemény⁶, Dezső Csupor⁹, Péter Hegyi¹⁰, Michael R. Filbin¹¹, Csaba Varga¹, Bánk G. Fenyves¹

1: Department of Emergency Medicine, Semmelweis University
2: András Pető Faculty, Semmelweis University
3: Budapest University of Technology and Economics, Department of Stochastics
4: Institute for Translational Medicine, Medical School, University of Pécs
5: Department of Pharmacognosy, Semmelweis University
6: Department of Dermatology, Venereology and Dermatooncology, Semmelweis University
7: Eötvös Loránd University, Faculty of Social Sciences, Department of Statistics
8: Institute of Pancreatic Diseases, Semmelweis University
9: Institute of Clinical Pharmacy, University of Szeged
10: Centre for Translational Medicine, Semmelweis University
11: Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School

Text of the abstract

Introduction
Early targeted antibiotics are key to better outcomes in sepsis. Rapid molecular assays (RMAs) can detect bloodstream infections (BSIs) faster than blood cultures (BCs), but their accuracy isn’t well established. We reviewed the literature to assess how well commercial RMAs perform compared to BCs.
Aims
To evaluate the diagnostic performance of commercially available RMAs for rapid pathogen detection of BSI in whole blood, compared to BC.
Method
We performed a systematic review and meta-analysis of studies from MEDLINE, Cochrane Library, Embase, and Web of Science (inception-September 23, 2024). Included studies enrolled patients with suspected or confirmed BSI tested with both a RMA (≤12 h turnaround, ≥20 pathogen targets) and BC. Animal studies and non-original articles were excluded. Primary outcomes were pooled sensitivity and specificity of RMAs versus BC. Bivariate analysis generated summary receiver operating characteristic curves and diagnostic metrics, stratified by unit of analysis, RMA type, and patient population. Risk of bias was assessed using QUADAS-2 and QUADAS-C. The study was registered in PROSPERO (CRD42022377280).
Results
Of 63,916 records, 104 studies were included in the qualitative and 75 in the quantitative synthesis, covering 17,952 samples and 11,393 patients (analyzed separately). Eleven RMAs were identified: four were included in RMA-specific subgroup analysis (SeptiFast, IRIDICA, SepsiTest, MagicPlex), five in the pooled analysis (UMD-SelectNA, VYOO®, MicrobScan, MicrobScan-Kairos24/7, REBA Sepsis-ID), and two in the qualitative synthesis only (InfectID-BSI, Pilot Gene Technology ddPCR). Pooled specificity (0.858; 95% CI: 0.830–0.883) was higher than sensitivity (0.659; 95% CI: 0.594–0.719) by patient. RMA-based sensitivity ranged from 0.492 (MagicPlex) to 0.783 (IRIDICA), and specificity by patient population ranged from 0.811 (ICU) to 0.892 (ED). Similar results were observed by sample. All studies were judged at high risk of bias.
Conclusion
RMAs offer shorter turnaround times but lack the sensitivity required to replace BCs. However, they may add diagnostic value as add-on tests by increasing overall pathogen detection. Advancements in assay sensitivity and high-quality clinical studies are needed to better define their role in clinical practice.
Funding
Centre for Translational Medicine, Semmelweis University.