The value of rapid-methods for pathogen identification and antibiotic resistance mechanism detection in optimizing antibiotic therapy: a narrative review

Antibiotic resistance represents one of the pressing challenges of contemporary clinical practice, as it contributes to increased mortality, prolonged hospitalization, and a growing economic burden on healthcare systems. This problem is of particular significance in infections caused by ESKAPE pathogens, carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa, for which the timely selection of rational antibacterial therapy directly affects prognosis. The aim of the present review is to synthesize current evidence on the value of rapid methods for pathogen identification and antibiotic resistance mechanism detection in optimizing antibiotic therapy. The literature search was conducted in PubMed/MEDLINE, eLibrary, CyberLeninka, Google Scholar, Springer Link, and ScienceDirect; a total of 70 publications were included in the analysis. The capabilities of multiplex PCR panels, MALDI-TOF MS, rapid phenotypic antimicrobial susceptibility testing methods, metagenomic sequencing, and ancillary biomarkers are examined. It has been demonstrated that rapid diagnostics can shorten the time to appropriate therapy, accelerate escalation upon detection of resistant strains, facilitate de-escalation, and reduce unnecessary antibiotic use. The most pronounced clinical effect is achieved when rapid diagnostic tests are integrated into antimicrobial stewardship programs involving microbiologists, clinical pharmacologists, and infectious disease specialists. At the same time, data on the impact of rapid diagnostics on mortality rates, length of hospital stay, and economic costs remain heterogeneous, which is attributable to local epidemiological indicators, the availability of technologies, the organization of laboratory workflows, and the quality of clinical interpretation of results.

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