RAPID DIAGNOSTICS FOR ORAL AND MAXILLOFACIAL INFECTIONS: IMPACT ON ANTIBIOTIC PRESCRIBING, REFERRAL TIMING, COMPLICATIONS, AND CARE PATHWAYS; A SYSTEMATIC REVIEW

Abstract Background: Oral and maxillofacial infections range from localized abscesses to deep neck infections with airway risk. Conventional culture is slow, which can prolong broad-spectrum antibiotics and delay targeted referral pathways. Rapid diagnostics, including biomarkers and molecular testing, may improve early risk stratification and antimicrobial stewardship. Objective: To evaluate the impact of rapid diagnostics (POCT, biomarkers, molecular tests, and sequencing-based microbiology) on antibiotic prescribing, referral timing, complications, and care pathways in oral and maxillofacial infections. Methods: We performed a PRISMA-guided systematic review of PMC-indexed full-text studies on rapid diagnostics in odontogenic, oral-maxillofacial infections and related head, neck infection pathways. Outcomes included antibiotic de-escalation, time to targeted therapy or referral, complications, and pathway, decision support. Studies were grouped into biomarker-based severity assessment and molecular, NGS pathogen and resistance characterization. Results: Ten original studies were included (n varied by study). Biomarker studies reported that procalcitonin and presepsin correlated with infection severity or systemic involvement and may support earlier escalation decisions. Molecular studies described polymicrobial profiles and resistance markers in abscess material and periodontal abscesses, supporting faster etiologic characterization compared with culture-dependent pathways. In a pediatric head, neck pathway study, nasal PCR availability was associated with faster de-escalation of anti-MRSA therapy without worse clinical outcomes. Conclusion: Rapid diagnostics show the strongest direct evidence for improving antibiotic decisions in pathway-based PCR stewardship and provide supportive evidence that biomarker and molecular testing can improve early stratification and organism, resistance recognition. More trials are needed linking these tools to time-to-referral, complication reduction, and standardized oral-maxillofacial care pathways.