The role of rapid and advanced microbiological methods in critical care: 2025 Emanuele Russo Delphi consensus

Scope: Interpretation of rapid and advanced microbiological test results remains nonstandardized, with no existing reference guidelines. This study aimed to analyse the existing evidence and provide expert guidance on the use of these techniques in critically ill patients. Methods: A Delphi consensus process was conducted by a multidisciplinary panel of experts, including microbiologists, infectious disease specialists, intensivists, surgeons, and pulmonologists. Sixteen prioritized key questions were addressed via literature reviews and two Delphi rounds. Consensus was reached when 70% of the responses showed strong agreement. Questions addressed by consensus and recommendations: Consensus was reached for all 16 statements. The key findings include the importance of interpreting rapid microbiological test results within a specific clinical context; the need for concurrent standard culture examinations alongside rapid tests to ensure the detection of all pathogens; the clinical usefulness of turnaround times <24 hours for rapid techniques; and the benefits of rapid diagnostics, particularly in severe sepsis and other severe infections. Specific recommendations were made regarding the use of rapid tests in various clinical settings (critically ill patients with suspected infection, pneumonia, and ventilator-associated pneumonia). The panel found insufficient evidence to support the routine use of digital polymerase chain reaction in various infection scenarios and concluded that clinical bioinformatics expertise is essential in microbiology laboratories that use advanced technologies. The panel also highlighted the need for basic clinician training to interpret data generated using advanced microbiological techniques. This consensus provides guidance for the appropriate use of rapid and advanced microbiological techniques for critically ill patients. However, the standardization of testing settings, interpretations, and cost-effectiveness analyses of different approaches requires further investigation. Robust preanalytical workflows and multidisciplinary clinical bioinformatics expertise are crucial for the effective implementation and interpretation of advanced techniques.