Balancing Speed and Cost: Economic Insights from Rapid Diagnostic Testing in Bloodstream Infections

Background: Rapid diagnostic tests (RDTs) for bloodstream infections (BSIs) reduce time to pathogen identification, yet evidence on their real-world economic and clinical value remains inconsistent. This study aimed to compare clinical outcomes, antibiotic utilization, and hospital costs associated with different rapid microbiological identification methods versus standard culture. Methods: A retrospective observational study was conducted in a tertiary university hospital including 115 hospitalized patients with suspected or confirmed BSIs. Multiplex PCR (mPCR), fluorescence in situ hybridization (FISH), and MALDI-TOF MS were compared with conventional culture. Outcomes included mortality, length of stay, antibiotic-days, and direct and indirect hospital costs. Nonparametric and exploratory adjusted analyses were performed. Results: No significant differences were observed across diagnostic groups for age, sex, mortality, or length of stay. Patients tested with mPCR showed higher empirical and total antibiotic-days and increased antibiotic-related costs (p < 0.05). Median direct and indirect hospital costs were numerically lower with FISH and mPCR but did not reach statistical significance. Adjusted analyses confirmed that diagnostic modality was not independently associated with mortality or costs. Conclusions: Rapid diagnostics accelerate identification but demonstrate heterogeneous downstream clinical and economic effects. Their value appears to depend more on local implementation and antimicrobial stewardship integration than on diagnostic speed alone.