Frontiers in Medicine Invited editorial Research Topic: Progressing the Understanding and Management of Bloodstream Infections Editorial: Progressing the Understanding and Management of Bloodstream Infections

Lihui Wang ¹ Bin Lin ² Xingrong Gong ¹ Yuetian Yu ^1*

• ¹ Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
• ² Changxing People's Hospital, Huzhou, Zhejiang Province, China

Bloodstream infections (BSIs) stand as a significant contributor to the global burden of infectious diseases, impacting both health and mortality on a widespread scale. Beyond the pivotal role of positive blood culture in confirming BSIs presence, healthcare providers grapple with myriad contributing factors. Consequently, an imminent imperative exists to explore novel avenues for diagnosing and treating BSIs, encompassing initiatives such as antimicrobial stewardship programs.Therefore, we have compiled this Research Topic on "Progressing the Understanding and Management of Bloodstream Infections", aiming for an in-depth discussion in the relevant fields. We are also pleased to receive a lot of submissions, and some of them have been successfully published after revisions. This Research Topic mainly focuses on the following areas. At the same time, for patients with a high suspicion of BSIs but negative culture results or suspected mixed infections with multiple pathogens, mNGS remains one of the best diagnostic technologies for identifying pathogens. It has been widely used in immunocompromised hosts, such as those with malignant hematological tumors and sepsis, and has improved the clinical prognosis of such patients (3)(4)(5)(6). Other point-ofcare testing (POCT) technologies based on rapid nucleic acid detection are also continuously being developed and applied, and relevant application consensus has been issued (7).BSIs often affect the host's immune function, primarily due to the release of a large number of inflammatory mediators (such as cytokines and chemokines) within the patient's body, leading to a systemic inflammatory response. This excessive inflammatory response can damage normal tissues and organs, inhibiting the body's immune function. At the same time, BSIs can lead to increased apoptosis of immune cells (such as T cells and B cells), reducing the number of effective immune cells, thereby weakening the body's immune response capability. If the patient's adaptive immune response to the BSIs is decompensated, it may induce the occurrence of sepsis.Therefore, in addition to promptly initiating effective antibiotics, rapidly achieving the effective concentration of these antibiotics is one of the significant challenges in the treatment. In critically ill patients, especially those with BSIs, the pathophysiology can change rapidly. Factors such as apparent volume of distribution (Vd), serum albumin levels, changes in liver and kidney function, and extracorporeal life support devices can all impact the effective concentration of antibiotics (8)