ArticleCureus2026
Laboratory-Negative Results as a Marker of Diagnostic Gap: A Retrospective Study in the One Health Context.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAntimicrobial resistance (AMR) is a major global health concern, driven in part by inappropriate antimicrobial use and diagnostic uncertainty. Laboratory-based diagnostics play a critical role in guiding rational therapy; however, a high proportion of laboratory-negative results may reflect potential gaps in diagnostic processes.
objectiveThe objective of this study is to assess the proportion of laboratory-confirmed infections among patients undergoing microbiological investigations and to explore a potential diagnostic gap using laboratory-negative results as an indirect and exploratory indicator.
methodsThis retrospective cross-sectional study was conducted in the Department of Microbiology of a tertiary care teaching hospital. A total of 1,304 microbiological samples, including serological, bacteriological, and mycological investigations, were analyzed. Data were extracted from laboratory records, and variables such as age, sex, department (OPD/IPD), type of investigation, and laboratory results were assessed. Positivity rates were compared across diagnostic modalities. Statistical analysis was performed using the chi-square test, with a p-value of <0.05 considered statistically significant.
resultsSerological investigations constituted the majority of samples (86.4%). The overall laboratory positivity rate was 19.9%, with 80.1% of samples showing no confirmed infection. Bacteriological investigations demonstrated a higher positivity rate (59.2%) compared to serology and mycology. Positivity rates varied across age groups, with higher rates observed among elderly patients. Modality-specific differences in diagnostic yield were observed, suggesting variability in test utilization patterns.
conclusionThis study demonstrates a high proportion of laboratory-negative results, indicating a potential diagnostic gap in clinical practice. These findings should be interpreted cautiously due to the influence of pre-analytical factors, analytical limitations, and variations in test utilization. Strengthening diagnostic stewardship and promoting microbiology-guided therapy are essential to optimize antimicrobial use. The results are interpreted within a one health perspective as a conceptual framework. Further prospective studies incorporating clinical correlation and antimicrobial exposure are required.
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