Rapid diagnostics to enhance therapy selection for the treatment of bacterial infections.

Purpose of review: Rapid diagnostic tests (RDTs) may reduce morbidity and mortality related to bacterial infections by reducing time to identification of pathogens and antibiotic resistance mechanisms. There has been a significant increase in the breadth and depth of available technology utilized by RDTs. Recent findings: There are numerous Food and Drug Administration (FDA)-cleared assays for rapid detection of bacteria from various specimen types from sites including blood, stool, central nervous system and respiratory tract. Most RDTs currently FDA-cleared are molecular tests designed as syndromic panels that provide identification of on-panel organisms and resistance genes. One FDA-cleared rapid phenotypic assay for antimicrobial susceptibility testing is currently available and others are in development. Studies of these technologies' clinical impact consistently demonstrate improvements in clinical care processes such as time to de-escalation and escalation of antibiotic therapy particularly for blood and respiratory specimen tests. Other RDTs show inconsistent impact on antibiotic use. Antimicrobial stewardship programs are vital to ensure the greatest benefit from RDTs in clinical practice. Summary: The advancement and implementation of RDTs, in conjunction with antimicrobial stewardship, to enhance treatment selection for bacterial infections should be regarded as a core element to improve clinical outcomes for patients. Although challenges exist in the use of RDTs, there is a need for continued innovation in technology, implementation science and collaboration across clinical professions to optimize care.