Rapid and robust diagnosis of bloodstream infections by single-cell analysis.

Summary

The STREAM platform combined pathogen enrichment with single-cell analysis to diagnose bloodstream infections directly from whole blood. Pathogen identification showed 96.15% concordance with clinical laboratory results, while single-cell antimicrobial susceptibility testing achieved 97.96% essential agreement and 93.9% categorical agreement across 219 drug-dose combinations. Complete diagnostic results were available within 6.75 to 17 hours, with detection limits as low as 0.1 to 1 CFU/ml.

Key Findings

• Pathogen identification from 104 positive blood culture samples had 96.15% concordance with clinical laboratory results.
• Single-cell antimicrobial susceptibility testing achieved 97.96% essential agreement and 93.9% categorical agreement across 219 drug-dose combinations.
• Direct whole-blood testing reached a detection limit of 0.1 to 1 CFU/ml and provided full results within 6.75 to 17 hours.

Clinical Implications

If validated in prospective clinical workflows, STREAM could shorten the time to pathogen-directed antimicrobial therapy and provide earlier susceptibility information than conventional blood culture. Its clinical effect on mortality, antibiotic use, and stewardship remains to be demonstrated.

Limitations

• The reported identification analysis used positive blood culture samples, so direct performance in consecutively suspected bloodstream infections is not established by the provided data.
• The abstract does not report patient-centered outcomes such as time to effective therapy, antibiotic consumption, or mortality.

Future Directions

Prospective multicenter studies should evaluate STREAM in consecutively enrolled patients with suspected bloodstream infection, compare it directly with standard-of-care workflows, and determine whether faster results improve antimicrobial selection, clinical outcomes, and resistance-related endpoints.