ArticleInfectious diseases and therapy2026
Comparison of Five Assays for Rapid Antimicrobial Susceptibility Testing (RAST), Including Disk Diffusion, MIC-Based Systems, and Genotypic Methods: A Prospective Evaluation.
Article in Infectious diseases and therapy, 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
introductionEarly and targeted therapy is pivotal for the outcome of bloodstream infection, a life-threatening condition with high mortality. EUCAST developed a protocol for rapid antimicrobial susceptibility testing (RAST) that allows testing directly from positive blood cultures (BCs). Recently, fully automated minimum inhibitory concentration (MIC)-based systems were introduced. This is the first study to compare two of these systems with agar-based RAST and genotypic resistance testing.
methodsNinety-seven Gram-negative BCs were prospectively analyzed using five different RAST assays. Agar-based RAST according to EUCAST was performed using conventional disk diffusion (DD) and a total laboratory automation solution (BD Kiestra), with reads at 4, 6, and 8 h. MIC-based, fully automated RAST was performed using VITEK Reveal (bioMérieux) and dRAST (Quantamatrix). Identification and genotypic resistance testing were additionally analyzed with the Biofire BCID2 multiplex PCR (bioMérieux).
resultsA total of 6715 genotypic and phenotypic results were compared with reference methods. Biofire achieved 100% sensitivity and specificity for species identification and resistance gene detection; 0-28% of BCs were unanalyzable due to missing RAST breakpoints. Categorical agreement ranged from 82.2% (4 h DD) to 95.4% (Reveal). Agar-based RAST yielded significantly more results in the area of technical uncertainty than other methods. Kiestra-based DD outperformed conventional DD after short incubation. Reveal had the highest rate of false-susceptible results (2.4%), particularly for penicillin. dRAST tended to false-resistant results (3.4%), particularly with motile organisms like Proteus mirabilis.
conclusionsAutomation of RAST provides more usable results than conventional DD, but each assay has specific weaknesses that users need to be aware of.
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