Prof. Holger Rohde
University Medical Center Hamburg Eppendorf, ESCMID AMR Action Subcommittee
Dr Chantal Morel
University of Bern, ESCMID AMR Action Subcommittee
In microbiological diagnostics, speed, accuracy and access determine survival. Yet the pathway from discovery to bedside to policy remains fragmented, with weak linkages between analytical validation and real-world performance.
Limited contextualisation of diagnostics across diverse clinical settings, alongside persistent affordability barriers, continues to constrain translation of innovation into measurable impact on antimicrobial resistance (AMR).
Multi-dimensional evaluation lens
A cross-silo, system-wide view is needed, one that moves beyond isolated assessment against narrow accuracy parameters. Diagnostic technologies are often evaluated in isolation rather than against their real impact on antimicrobial stewardship and resistance containment.
Effective evaluation must combine diagnostic accuracy with health economic value, capturing reductions in antibiotic misuse, improvements in patient outcomes and system-wide cost savings. Prioritisation should rank rapid point-of-care tests, pathogen identification tools and resistance detection platforms by feasibility, equity and population-level benefit, including beyond the short-term
Where appropriate, it should also be grounded in a One Health approach linking environmental surveillance, animal reservoirs and clinical diagnosis.
By integrating science, economics and public health priorities, diagnostics can become a cornerstone of sustainable antimicrobial stewardship and global health security
Restructuring reimbursement is a pivotal lever. Payment systems must shift from volume-based to value-based models that reward diagnostics which demonstrably improve care quality and curb unnecessary prescribing. Without aligned incentives, inappropriate antimicrobial use will persist, eroding the efficacy of even the newest therapies.
Investment in innovation must be matched by investment in implementation, infrastructure, workforce training and laboratory capacity. This is also needed in low- and middle-income countries where diagnostic gaps directly drive empirical broad-spectrum prescribing.
A systems response to a systems failure
AMR isn’t only a scientific challenge but also suggests a systems failure, demanding coordinated action across disciplines and borders. Closing the evidence and practice gap requires transparent data sharing, robust real-world studies and continuous post-market evaluation of diagnostic tools.
Policy frameworks should incentivise early adoption of high-value diagnostics while discouraging low-impact or redundant testing. Some global coordination is also essential to ensure equitable access, particularly in resource-limited settings where the AMR burden is highest.
By integrating science, economics and public health priorities, diagnostics can become a cornerstone of sustainable antimicrobial stewardship and global health security, strengthening resilience for future generations through faster detection, smarter treatment and stronger systems, ultimately saving lives globally.
