Comparative Approaches to Antimicrobial Resistance Testing in Sepsis: E-Test and Molecular Diagnostics – A Scoping Review
DOI:
https://doi.org/10.59141/-.v8i2.512Keywords:
Sepsis, Antimicrobial susceptibility testing, E-test, Molecular diagnosticsAbstract
Sepsis remains a major global health problem with high morbidity and mortality. Rapid antimicrobial susceptibility testing (AST) is essential, but conventional methods are time-consuming and may delay appropriate therapy. This study aimed to compare phenotypic methods, particularly the E-test, and molecular diagnostics for antimicrobial susceptibility testing in sepsis. A scoping review was conducted using PubMed, ScienceDirect, and other sources for studies published between 2016 and 2026. From 214 identified records, 10 studies met the inclusion criteria and were analyzed. Molecular diagnostics provided results within 1–8 hours, while rapid phenotypic methods required 3–7 hours, compared to 48–96 hours for conventional methods. Molecular approaches showed high resistance detection accuracy (up to 99%), whereas phenotypic methods demonstrated high agreement with reference standards (>95–99%). Rapid diagnostics improved antimicrobial therapy optimization, with treatment modification reported in up to 21% of patients. Phenotypic and molecular methods have complementary strengths. Molecular diagnostics offer speed, while phenotypic methods such as the E-test ensure accuracy. An integrated approach may improve antimicrobial stewardship and clinical outcomes in sepsis.
Downloads
References
Banerjee, R., & Humphries, R. (2021). Rapid Antimicrobial Susceptibility Testing Methods for Blood Cultures and Their Clinical Impact. Frontiers in Medicine, 8(March). https://doi.org/10.3389/fmed.2021.635831
Caunedo-Jiménez, M., Fernández-Colomer, B., Fernández-Suárez, J., Arias-Llorente, R. P., Lareu-Vidal, S., Mantecón-Fernández, L., Solís-Sánchez, G., & Suárez-Rodríguez, M. (2023). Clinical Utility of the FilmArray® Blood Culture Identification (BCID) Panel for the Diagnosis of Neonatal Sepsis. Microorganisms, 11(3), 1–9. https://doi.org/10.3390/microorganisms11030732
Chilleri, C., Salvetti, S., Coppi, M., Montenora, I., Giani, T., Rossolini, G. M., & Antonelli, A. (2026). Evaluation of the Performance of Novel Gram-Negative and Gram-Positive Sepsis Panels for the Rapid Diagnosis of Bloodstream Infections. Diagnostics, 16(3), 1–9. https://doi.org/10.3390/diagnostics16030481
Giacobbe, D. R., Crea, F., Morici, P., Magnasco, L., Di Pilato, V., Briano, F., Willison, E., Pincino, R., Dettori, S., Tutino, S., Esposito, S., Coppo, E., Dentone, C., Portunato, F., Mikulska, M., Robba, C., Vena, A., Battaglini, D., Brunetti, I., … Bassetti, M. (2022). T2Bacteria and T2Resistance Assays in Critically Ill Patients with Sepsis or Septic Shock: A Descriptive Experience. Antibiotics, 11(12), 1–7. https://doi.org/10.3390/antibiotics11121823
Idelevich, E. A., & Becker, K. (2019). How to accelerate antimicrobial susceptibility testing. Clinical Microbiology and Infection, 25(11), 1347–1355. https://doi.org/10.1016/j.cmi.2019.04.025
Lamy, B., Sundqvist, M., & Idelevich, E. A. (2020). Bloodstream infections – Standard and progress in pathogen diagnostics. Clinical Microbiology and Infection, 26(2), 142–150. https://doi.org/10.1016/j.cmi.2019.11.017
MacVane, S. H., & Dwivedi, H. P. (2024). Evaluating the impact of rapid antimicrobial susceptibility testing for bloodstream infections: a review of actionability, antibiotic use and patient outcome metrics. Journal of Antimicrobial Chemotherapy, 79, i13–i25. https://doi.org/10.1093/jac/dkae282
Marino Miguélez, M. H., Osaid, M., Hallström, E., Kaya, K., Larsson, J., Kandavalli, V., Wählby, C., Elf, J., & van der Wijngaart, W. (2025). Culture-free detection of bacteria from blood for rapid sepsis diagnosis. Npj Digital Medicine, 8(1). https://doi.org/10.1038/s41746-025-01948-w
Matúšková, L. S., Vladárová, M., & Nováková, E. (2026). Rapid Bacterial Identification and Quantitative Antimicrobial Susceptibility Assessment from Positive Blood Cultures to Optimize Bloodstream Infection Management. 1–14.
Migliorisi, G., Calvo, M., Collura, A., Di Bernardo, F., Perez, M., Scalia, G., & Stefani, S. (2024). The Rapid Phenotypic Susceptibility Testing in Real-Life Experience: How the MIC Values Impact on Sepsis Fast Diagnostic Workflow. Diagnostics, 14(1). https://doi.org/10.3390/diagnostics14010056
Olsson, A., Rafeletou, A., Åman, A., Athanasiou, N., García-Rivera, C., Gerstbrein, D., Mesich, B., Patterson, L., Vahturova, J., VanZeeland, N., Ricart-Silvestre, A., Faron, M. L., Hoff, J., Alby, K., Ivanova, M., Díaz, J. C. R., Johansson, C., & Malmberg, C. (2025). Multicenter evaluation of the QuickMIC® rapid AST system in clinical practice: impact on turnaround time compared to routine AST systems. European Journal of Clinical Microbiology and Infectious Diseases, 185–196. https://doi.org/10.1007/s10096-025-05298-z
Park, S., Kim, D., & Ryoo, N. (2025). Comparative Assessment of Rapid Identification and Antimicrobial Susceptibility Testing Methods for Bloodstream Infections in a Non-24/7 Clinical Microbiology Laboratory. Microorganisms, 13(5), 1–21. https://doi.org/10.3390/microorganisms13051041
Pinzauti, D., Biazzo, M., Podrini, C., Alevizou, A., Safarika, A., Damoraki, G., Koufargyris, P., Tasouli, E., Skopelitis, I., Poulakou, G., Sympardi, S., & Giamarellos-Bourbolis, E. J. (2025). An NGS-assisted diagnostic workflow for culture-independent detection of bloodstream pathogens and prediction of antimicrobial resistances in sepsis. Frontiers in Cellular and Infection Microbiology, 15(September), 1–11. https://doi.org/10.3389/fcimb.2025.1656171
Reszetnik, G., Hammond, K., Mahshid, S., AbdElFatah, T., Nguyen, D., Corsini, R., Caya, C., Papenburg, J., Cheng, M. P., & Yansouni, C. P. (2024). Next-generation rapid phenotypic antimicrobial susceptibility testing. Nature Communications , 15(1). https://doi.org/10.1038/s41467-024-53930-x
Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., Colombara, D. V., Ikuta, K. S., Kissoon, N., Finfer, S., Fleischmann-Struzek, C., Machado, F. R., Reinhart, K. K., Rowan, K., Seymour, C. W., Watson, R. S., West, T. E., Marinho, F., Hay, S. I., … Naghavi, M. (2020). Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet, 395(10219), 200–211. https://doi.org/10.1016/S0140-6736(19)32989-7
Seymour, C. W., Gesten, F., Prescott, H. C., Friedrich, M. E., Iwashyna, T. J., Phillips, G. S., Lemeshow, S., Osborn, T., Terry, K. M., & Levy, M. M. (2017). Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. New England Journal of Medicine, 376(23), 2235–2244. https://doi.org/10.1056/NEJMoa1703058
Singer, M. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) | Critical Care Medicine | JAMA | JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/2492881%0Ahttp://files/424/2492881.html
So, M. K., Kim, S. K., Chung, H. S., Bae, J. Y., & Lee, M. (2023). Large-Scale Clinical Evaluation of Rapid Blood Culture Identification Panels for Bloodstream Infections at a Tertiary Hospital. Diagnostics, 13(6). https://doi.org/10.3390/diagnostics13061177
Timbrook, T. T., Morton, J. B., Mcconeghy, K. W., Caffrey, A. R., Mylonakis, E., & LaPlante, K. L. (2017). The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: A systematic review and meta-analysis. Clinical Infectious Diseases, 64(1), 15–23. https://doi.org/10.1093/cid/ciw649
Zalas-Więcek, P., Bogiel, T., & Gospodarek-Komkowska, E. (2022). The Accelerate PhenoTM System—A New Tool in Microbiological Diagnostics of Bloodstream Infections: A Pilot Study from Poland. Pathogens, 11(12). https://doi.org/10.3390/pathogens11121415
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Putu Ngurah Pradnya Wibawa, Ni Putu Lia Juliantini, Ni Luh Putu Serly Ekayanti
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aCreative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
