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.
Background: Transporting critically ill trauma patients for fluoroscopy-guided peripherally inserted central catheter (PICC) placement poses substantial risks. This study evaluated the clinical outcomes of bedside PICC insertion using a surface anatomical landmark-based measurement in a trauma intensive care unit (ICU).Methods: This retrospective cohort study included trauma ICU patients who underwent PICC insertion between September 2023 and August 2024 at a regional trauma center. Insertion location was categorized as bedside or fluoroscopy-guided. Outcomes included optimal tip positioning, aberrant-course malposition, complication rates, and catheter dwell time. Multivariable linear regression identified factors associated with PICC duration.Results: Among 282 PICC procedures (171 bedside, 111 fluoroscopy), the bedside group had significantly higher injury severity scores and more frequent mechanical ventilation. Using the cm-based carina-distance criterion, optimal tip positioning was achieved in 73.1% of bedside and 65.5% of evaluable fluoroscopy-guided insertions (P=0.184). However, using the vertebral body unit-based radiologic criterion, target-zone achievement was lower in the bedside group than in the fluoroscopy group (48.5% vs. 64.9%). Initial aberrant-course malposition occurred in nine bedside insertions (5.3%) and in no fluoroscopy-guided insertions, and all were corrected before clinical use. Overall complication rates were comparable (17.5% vs. 18.0%, P=0.919). Conclusions: Bedside PICC insertion using a surface anatomical measurement method may be a feasible transport-free option for selected critically ill trauma ICU patients.
