Modification of the rapid antimicrobial susceptibility testing from blood culture protocol for a resource-limited setting.

Background: Sepsis is a medical emergency and rapid antimicrobial susceptibility testing (RAST) is essential for patient management. However, existing RAST protocols may be unsuitable for resource-limited settings due to the need for rapid species identification, which may require specialized equipment or expensive reagents. Aims: To minimize the requirement of the RAST protocol while maintaining its efficacy, focusing on Methods: Positive blood cultures suspected of having these pathogens underwent RAST with three main modifications: delayed species identification, implementation of pan-species breakpoints and the change in the quality control process. Twelve antimicrobials were tested for Gram-negative bacilli, and three for Results: Among 398 samples, gentamicin, ampicillin, meropenem and trimethoprim-sulfamethoxazole met the accuracy criteria for Gram-negative bacilli. Ceftriaxone, imipenem and ciprofloxacin had slightly reduced agreement (80%-90%) due to a high false resistance. The remaining antimicrobials either had a low agreement or high false susceptibility. Only gentamicin passed the agreement criteria for Conclusion: RAST reduced the time-to-result for key antimicrobial agents for at least 24 h while requiring minimal workflow disruption, enabling early adjustment of antimicrobial treatment.