Introduction: The increase of antibiotic-resistant strains in bacterial pathogens is one of the important causes of death in infectious diseases. Therefore, focusing on studies related to antibiotic resistance has become a priority of the World Health Organization (WHO), which includes finding ways to quickly detect resistance and ways to deal with it. Rapid diagnosis of antibiotic resistance is very useful for choosing the right and best antibiotic for effective disease management. Conventional laboratory methods for determining antibiotic resistance are often culture-based and require several days to provide results. Therefore, in order to manage the consumption of antibiotics and optimize the treatment process, various rapid tests have been developed to facilitate the immediate identification of antibiotic resistance in bacterial pathogens.
Methods: This manuscript provides a comprehensive review of current methods of rapid tests for the detection of antibiotic resistance, focusing on methodology, accuracy, sensitivity, and clinical utility. We classified the methods for the rapid detection of antibiotic resistance into three main groups based on the method used: molecular methods, immunological assays and phenotypic tests. In molecular methods, different techniques are used, starting from polymerase chain reaction (PCR) and reaching next generation sequencing (NGS) in the most advanced state. In molecular methods, there is sensitivity and specificity of the test in identifying resistance genes directly from patient samples. Immunological assays, such as enzyme-linked immunosorbent assays (ELISA), use specific antibodies to detect markers of resistance in the target pathogen. Therefore, by targeting the resistance marker, it is possible to quickly diagnose and accurately report it on the clinical sample. Although some technologies are designed based on the same phenotypic tests, they allow rapid response. Phenotypic methods such as broth microdilution, together with rapid formats such as lateral flow, have made it possible to test the results of bacterial susceptibility to a variety of antibiotics in the shortest possible time.
Results: We performed a systematic review of available research results and analyzed the diagnostic performance of rapid antibiotic susceptibility tests and noted their advantages and limitations. Meta-analyses have shown that tests based on molecular techniques are highly accurate, but require sophisticated laboratory instruments and trained personnel. Conversely, immunological and phenotypic tests are easier but more sensitive compared to molecular tests. Also, we discussed the challenges of applying rapid antibiotic susceptibility tests at the bedside and the measures required for monitoring, standardization and integration with current common methods. Finally, the importance of rapid detection of antimicrobial resistance has been raised not only from the point of view of management of infectious diseases, but also in controlling the increase of antibiotic-resistant strains along with presenting case studies. In this way, quick methods of determining sensitivity to antibiotics increase the success of patient treatment, reduce treatment costs and better control infection in medical centers.
Conclusion: In conclusion, this manuscript emphasizes the urgent need for rapid and reliable tests to detect antibiotic resistance in the face of a public health crisis. We have performed a comprehensive review of rapid methods for determining antibiotic susceptibility and compared their advantages and limitations with conventional methods. In this way, rapid methods to determine resistance to antibiotics have been very valuable in the management of bacterial infections and have created new hope to control the spread of drug-resistant strains. Focusing on research to address the limitations and gaps in knowledge is a necessary step to apply rapid methods of drug sensitivity determination in the clinic and benefit from its benefits.