Fast Results, No Plan to Use Them

Rapid antimicrobial resistance (AMR) diagnostic tests — which can identify pathogens and resistance markers in hours instead of days — have been developed and FDA-cleared, but clinical trials (BCID, RAPIDS GN) demonstrated that these tests do not improve patient outcomes (mortality, length of stay, readmissions) when deployed without integrated antibiotic stewardship programs. Rapid tests decreased time-to-appropriate-therapy but showed no significant differences in clinical outcomes. Results only improved when rapid diagnostics were paired with active antibiotic stewardship team oversight — but no standardized implementation framework exists for integrating rapid diagnostics into stewardship workflows, and most hospitals lack the staffing for 24/7 stewardship coverage.

Antimicrobial resistance kills an estimated 1.27 million people annually worldwide and is projected to reach 10 million annual deaths by 2050. Billions of dollars have been invested in developing rapid AMR diagnostics, yet the technology is not translating into better outcomes because it was developed as a laboratory technology solution without accounting for the clinical decision-making infrastructure needed to act on rapid results. Clinical guidelines provide "sporadic recommendations" for rapid testing without clarity on how and when to use them, and minimal data exist on how diagnostic results affect hospital formulary access policies.

Rapid molecular diagnostics — blood culture identification panels (BCID), rapid antimicrobial susceptibility testing (AST) systems, multiplex PCR panels — have been FDA-cleared and adopted by many hospitals. But deployment as a laboratory upgrade — faster results delivered through the same reporting channels — does not change prescribing behavior. Antibiotic stewardship programs (ASPs) exist in most US hospitals per the 2017 CMS mandate, but typically have limited staffing (1–2 pharmacists for an entire hospital) and cannot provide real-time guidance for every positive culture result. Clinical decision support systems for antimicrobial prescribing are underdeveloped and poorly integrated with microbiology laboratory result workflows — results arrive as text reports in EHRs rather than as actionable prescribing recommendations.

Workflow integration frameworks that embed rapid diagnostic results directly into clinical decision support at the point of prescribing — not as laboratory reports but as treatment recommendations with local antibiogram context. Automated stewardship algorithms that can provide evidence-based prescribing guidance when human stewardship teams are unavailable (nights, weekends, small hospitals without dedicated ASPs). Reimbursement models that value the diagnostic-plus-stewardship integration, not just the test itself.

A student team could map the complete information flow from rapid diagnostic result to prescribing decision at a specific hospital to identify bottlenecks and design an integrated workflow prototype, or develop a clinical decision support tool that translates rapid AST results into antibiotic treatment recommendations using published antibiogram data and IDSA guidelines. Alternatively, teams could design an automated stewardship alert system for after-hours coverage. Relevant disciplines: clinical informatics, health systems engineering, microbiology, pharmacy, human factors engineering.