Rapid Molecular Diagnostics for Bloodstream Infection in Patients with Chronic Kidney Disease

Bloodstream infection (BSI) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), particularly those receiving hemodialysis. Delayed identification of pathogens and their resistance profiles can lead to inappropriate therapy and adverse outcomes. This review evaluates rapid molecular diagnostic approaches for detecting pathogens and resistance markers in BSI, with emphasis on their application in CKD. These technologies provide faster microbiological information by enabling direct or accelerated detection of pathogens and selected resistance determinants. Clinical studies indicate that their use supports prompt adjustment of antimicrobial therapy, especially when combined with antimicrobial stewardship and applied after blood culture positivity. In CKD, identification of the causative organism facilitates treatment selection aligned with renal function and helps reduce unnecessary exposure to nephrotoxic agents. However, diagnostic accuracy differs among platforms, and detection of resistance genes does not consistently reflect phenotypic susceptibility. Furthermore, most evidence is derived from mixed hospital populations rather than CKD-specific cohorts. These factors require careful interpretation within the clinical context. Rapid molecular diagnostics can enhance antimicrobial decision-making in BSI, but their effectiveness depends on integration with conventional microbiology and structured care pathways. Further research in CKD populations is required to clarify their impact on clinical outcomes and to support implementation in nephrology practice.