Comparative performances of the Qvella FAST system and conventional methods for rapid identification and antibiotic susceptibility testing on monomicrobial positive blood cultures

Rapid and accurate diagnosis of sepsis is of paramount importance to reduce associated morbidity and mortality. The Qvella FAST System is a new instrument that concentrates and purifies bacteria from positive-flagged blood culture bottles (PFBCBs) to produce a "liquid" colony comparable to a subcultured colony in less than 40 min for rapid ID and calibrated antibiotic susceptibility testing (AST). In this study, we evaluated performances of the FAST System workflow and our rapid routine manual workflow (bacterial pellet obtained after lysis, cleaning, washing, and centrifugation for ID; AST by disc diffusion by direct inoculation after dilution) by comparison to the reference method based on 24-h bacterial subcultures. Two panels of PFBCBs were studied: panel A (including 107 prospective BCs from septic patients, October-November 2022) and panel B (including 102 BCs spiked with difficult-to-identify bacteria [mostly streptococci] and multidrug-resistant isolates), resulting in a total of 209 evaluable samples. The FAST System provided a correct ID to the species level in 178/209 (85.2%) of cases. For AST, the categorical agreement (CA) of the FAST System was 99.4%, with rates of very major (VME), major (ME), and minor (mE) errors of 0.59%, 0.20%, and 0.26%, respectively. Our rapid routine workflow based on manual methods show similar results for ID (86.2%) and AST (CA, 99.6%; VME, 0.50%; ME, 0.16%; mE, 0.13%). In conclusion, the Qvella FAST system, a promising tool that can reduce diagnostic time by approximately 1 day, shows excellent performances for rapid ID and AST.