Assessing the impact of rapid syndromic infection testing panel on diagnostic capacity and clinical and public health management in small island developing states

Background: Many of the UK overseas territories (UKOTs) are small with limited microbiological diagnostic capacity for pathogens and antimicrobial resistance detection. The COVID-19 pandemic highlighted the vulnerability of these territories for the emergence of novel infections and antimicrobial resistance. Objective: To describe the process and clinical implications of implementing rapid automated syndromic molecular diagnostics (RASM) in the UKOTs, evaluating the outcome in enhancing individual patient management, communicable disease control, and antimicrobial stewardship. Methods: The UKOT program with its territory partners implemented RASM in March-May 2023, aiming to improve diagnostic capacity. Local laboratory staff were trained in the use of the diagnostics, and guidance was provided to clinicians for requesting tests. Syndromic diagnoses included enteric, respiratory, bloodstream, neurological infection, and antibiotic resistance mechanisms. Data on diagnostic capacity, turnaround times, and clinical impact were collected from records before and after the implementation of RASM. Results: Turnaround time for results went from an average of 14 days to 1 day, and often much shorter (1 hour). The range of enteric, respiratory, and neurological pathogens was extended. Antibiotic resistance mechanisms could be detected for the first time. Previously undiagnosed conditions could now be identified rapidly at the microbiological level in the territory, allowing appropriate specific clinical management, infection prevention, improved antimicrobial stewardship, and rapid public health response. Conclusion: Rapid microbiological diagnosis on-site transformed patient management, the timely investigation and management of outbreaks and clusters, accurate surveillance, and antimicrobial stewardship. Targeted RASM is likely to be cost-effective, reducing the requirement for highly trained scientific staff and expensive logistics around rapid transport to reference laboratories. Further cost analyses would be useful. This technology is simple to operate and maintain with little scope for user error. The speed of microbiological diagnosis for patient management and public health intervention was greatly enhanced.