Rapid microbiological diagnostics for sepsis in critical care: integrating technological advances with antimicrobial stewardship.

Sepsis is a life-threatening medical emergency in which prompt initiation of targeted antimicrobial therapy is crucial for patient survival. Historically, clinicians have relied on empirical broad-spectrum antibiotics owing to the 48-to-72-hour turnaround time of conventional blood cultures, while traditional host-response biomarkers offer limited pathogen-specific utility. This review highlights the recent paradigm shift in the microbiological diagnostics for sepsis, which is transitioning from conventional methods to rapid diagnostic tests (RDTs). Pre-analytic considerations for blood culture are of paramount importance as the foundation for all downstream RDT applications. We explore the clinical integration of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and highly multiplexed genotypic assays, which provide rapid species identification and limited profiles of genotypic resistance directly from positive blood cultures. The critical need for rapid phenotypic antimicrobial susceptibility testing is addressed, alongside the emerging technologies for culture-independent microbial detection. Crucially, technological advancement alone is insufficient: the true clinical benefits of RDTs would be achieved only when RDTs are coupled with robust diagnostic and antimicrobial stewardship programs. In the context of globally escalating antimicrobial resistance, and with a specific focus on the high prevalence of multidrug-resistant organisms in South Korea, the seamless integration of these advanced diagnostic systems into multidisciplinary clinical workflows underscores the urgency and opportunities of this paradigm shift.