Clinical performance of the VITEK REVEAL fast antimicrobial susceptibility test within a real-world workflow for gram-negative bacteremia: comparison with QMAC-dRAST and conventional methods

Fast antimicrobial susceptibility testing is critical for initiating appropriate therapy in patients with gram-negative bacteria-induced bloodstream infections. Conventional antimicrobial susceptibility testing methods often require extended turnaround times, thereby delaying optimal treatment. In this study, we prospectively evaluated the VITEK REVEAL system, which detects bacterial growth-associated volatile organic compounds to directly determine antimicrobial susceptibility in positive blood cultures. We assessed the system against our already established identification and antimicrobial susceptibility testing methods, including both fast and conventional platforms currently implemented in routine clinical practice. The volatile organic compounds-based system demonstrated high concordance, shorter time-to-results, and reliable performance for newer antimicrobial agents. By directly comparing its performance with established clinical diagnostic tools, this study provides relevant support for the potential integration of this approach into real-world laboratory workflows, with implications for improved patient management and antimicrobial stewardship.