Treatment assessment and patient outcome for sepsis depend predominantly on the timely administration of appropriate antibiotics^1,2,3. However, the clinical protocols used to stratify and select patient-specific optimal therapy are extremely slow⁴. In particular, the major hurdle in performing rapid antimicrobial susceptibility testing (AST) remains in the lengthy blood culture procedure, which has long been considered unavoidable due to the limited number of pathogens present in the patient’s blood. Here we describe an ultra-rapid AST method that bypasses the need for traditional blood culture, thereby demonstrating potential to reduce the turnaround time of reporting drug susceptibility profiles by more than 40–60 h compared with hospital AST workflows. Introducing a synthetic beta-2-glycoprotein I peptide, a broad range of microbial pathogens are selectively recovered from whole blood, subjected to species identification or instantly proliferated and phenotypically evaluated for various drug conditions using a low-inoculum AST chip. The platform was clinically evaluated by the enrolment of 190 hospitalized patients suspected of having infection, achieving 100% match in species identification. Among the eight positive cases, six clinical isolates were retrospectively tested for AST showing an overall categorical agreement of 94.90% with an average theoretical turnaround time of 13 ± 2.53 h starting from initial blood processing.

败血症的治疗评估和患者结果主要取决于及时施用适当的抗生素^1,2,3 。然而，用于分层和选择患者特定最佳治疗的临床方案极其缓慢⁴ 。特别是，进行快速抗菌药物敏感性测试（AST）的主要障碍仍然是漫长的血培养程序，由于患者血液中存在的病原体数量有限，长期以来一直被认为是不可避免的。在这里，我们描述了一种超快速 AST 方法，该方法绕过了传统血培养的需要，从而证明了与医院 AST 工作流程相比，可以将报告药物敏感性概况的周转时间缩短 40-60 小时以上。通过引入合成的 β-2-糖蛋白 I 肽，可以选择性地从全血中回收多种微生物病原体，进行物种鉴定或使用低接种量 AST 芯片立即增殖并针对各种药物状况进行表型评估。该平台通过入组190名疑似感染的住院患者进行临床评估，实现物种鉴定100%匹配。在 8 个阳性病例中，对 6 个临床分离株进行了 AST 回顾性检测，结果显示总体分类一致性为 94.90%，从初始血液处理开始的平均理论周转时间为 13 ± 2.53 小时。