The FAST randomized clinical trial, published in JAMA, evaluated whether rapid antimicrobial susceptibility testing (AST) directly from positive blood cultures could improve outcomes for patients with gram-negative bloodstream infections compared with standard testing.
The trial results are also highlighted in a JAMA editorial as well as a JAMA research summary and Editors’ Summary podcast. These materials place the FAST findings in the broader context of antimicrobial resistance, diagnostic innovation, and antibiotic stewardship.
The multinational trial included 850 patients in the primary analysis across seven medical centers in Greece, India, Israel, and Spain – regions with high levels of antimicrobial resistance. Patients were randomized to rapid phenotypic AST plus standard testing or standard testing alone, with antimicrobial stewardship teams reviewing all patients and providing treatment recommendations.
The study found that rapid AST was not superior to standard AST for achieving a more desirable day-30 outcome using a Desirability of Outcome Ranking (DOOR) endpoint. However, rapid testing was associated with faster antibiotic escalation or de-escalation, a finding that may help inform how rapid diagnostic tools are used alongside stewardship programs in clinical practice.
- Learn more: “Fast Antimicrobial Susceptibility Testing for Gram-Negative Bacteremia: The FAST Randomized Clinical Trial”
- Read the JAMA editorial: “A Multinational Trial of Rapid Antimicrobial Susceptibility Testing Is FASTer Better?”
- Listen to the JAMA Editors’ Summary Podcast
- Read the JAMA Research Summary