Enhancing Bloodstream Infection Management: A Systematic Review of Rapid Diagnostic Tests and Their Integration Into Antimicrobial Stewardship Programs.

This systematic review evaluates the effect of rapid diagnostic tests (RDTs) on clinical outcomes in patients with bloodstream infections (BSIs), with particular emphasis on their integration into antimicrobial stewardship programs (ASPs). A comprehensive literature search across PubMed, Scopus, Embase, and the Cochrane Central Register of Controlled Trials identified randomized controlled trials (RCTs) and post-hoc analyses that compared RDTs, including multiplex polymerase chain reaction (PCR), matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and rapid phenotypic antimicrobial susceptibility testing (AST), with conventional microbiological workflows. Studies were assessed for methodological quality using the Cochrane risk of bias tool. Outcomes of interest included time to effective therapy, antimicrobial optimization, mortality, and hospital length of stay. The included RCTs consistently demonstrated that RDTs, particularly when paired with ASP interventions, accelerated therapeutic decisions and improved antibiotic targeting compared with conventional methods. Importantly, this review is novel in restricting inclusion to RCT evidence and in examining individual diagnostic modalities, offering more granular insights than prior reviews that pooled heterogeneous study types. However, variability in study design, population characteristics, and outcome definitions highlights the need for standardized research approaches and consistent integration with stewardship frameworks. Overall, the findings support the clinical value of RDTs in enhancing BSI management and optimizing antimicrobial therapy, while underscoring that their impact is maximized when embedded within structured ASPs. These results carry important implications for both high-income and resource-limited healthcare settings, reinforcing the role of diagnostic stewardship in translating rapid results into improved patient outcomes.