Roadmap for emerging antimicrobial susceptibility testing and its clinical adaptation, from bench to bedside

The rapid emergence of antimicrobial resistance (AMR) underscores the urgent need for accurate and timely antimicrobial susceptibility testing (AST) to guide effective antibiotic treatment. Currently, various AST techniques have evolved, however, no single, globally adopted rapid diagnostic technology available for AST diagnosis. Disk diffusion remains a widely accepted technique around the world for AST detection, despite its limitations and ineffective antibiotic efficacy. Regardless of antimicrobial stewardship program, these delayed diagnosis lead to the overuse of broad-spectrum antibiotics to primarily treat the infections and contribute to AMR development. Although automated AST systems offer improved sensitivity and effective in rapid diagnosis, their limited accessibility in low-resource settings and expensive test cost hinders its widespread adaptation. Emerging innovative AST technologies show promise in point-of-care testing but require validation and integration into clinical workflows. Clinical AST market demands differentiated solutions like high-throughput automation for well-resourced settings and affordable semi-automated solutions for low-resource healthcare areas. Therefore, this review extensively addresses the integration of existing AST technologies with emerging techniques, the key challenges in development, regulatory compliance, and clinical implementation. Additionally, highlight the urgent need for next-generation semi-automated AST technology to balance efficacy and affordability for improving individual patient outcomes in the global fight against AMR.