Antimicrobial Resistance: The Diagnostic Bottleneck We Cannot Ignore

Antimicrobial resistance (AMR) is a growing global health emergency: in 2021, 4.71 million deaths were linked to infections resistant to drugs, of which 1.14 million were directly due to AMR—and we risk seeing this increase to nearly 1.91 million AMR-associated deaths per annum by 2050 (1). One of the major, under-discussed causes of this menace is the diagnostic gap: in low- and middle-income nations, the delay in culture and sensitivity reports has clinicians making decisions on the basis of broad-spectrum empiric therapy, which itself promotes resistance. Pathologists and microbiologists are key players in filling the gap.Milestone technologies—ultra-rapid antibiotic susceptibility platforms (viz., SERS-AST)—generate same-day MIC values, providing timely, target antimicrobial therapy (2). Furthermore, the WHO’s Antimicrobial Resistance Diagnostic Initiative (2023) places diagnostics at center stage highlighting lab capacity building, equitable access to quality testing, and inclusion of diagnostic testing in stewardship and surveillance (3). Our Three-Step Strategy of Action: Improving diagnosis: Install rapid AST systems to allow same-day MIC reporting. Stewardship via data: Regularly generate and disseminate institutional antibiograms; align with WHO’s AWaRe prescribing framework (4). Laboratory empowerment: Formalize inclusion of pathologists in antimicrobial stewardship committees in a way that laboratory diagnostics inform clinical decision-making in real-time. Pathology is not a spectator during the AMR war, but rather must be the proactive center. Reform focused on diagnosis, established today, is required in order to avoid a post-antibiotic world.