Towards rapid sepsis diagnosis and patients stratification : What's new from microbiology and omics science

Early etiological diagnosis and characterization of host response to infection are becoming central in sepsis recognition and management. Still, limitations in conventional diagnosis and patient stratification contribute to the high mortality rates of septic patients despite new antimicrobials and resuscitation agents. Novel microbiological techniques and omics analyses have recently led to the development of several tests that are now commercially available or in the pipeline as rapid diagnostic tools. In this review, we first summarize emerging assays for the etiological diagnosis starting directly from whole blood, based on target-specific PCRs or metagenomics. We then investigate results of different omics approaches for both bedside diagnosis of immune dysfunction and detection of patients' signatures associated with different clinical outcomes or potential response to individualized therapies. Finally, we discuss about the translation of these novel laboratory tools into clinical practice, showing how their best performance is achieved when integrated within antimicrobial stewardship programs.