Optimizing Detection of Antimicrobial-Resistant Escherichia coli: A Review of Traditional, Rapid, and Emerging Diagnostic Technologies

Abstract

Antimicrobial resistance (AMR) in Escherichia coli (E. coli) significantly compromises global healthcare, driving up morbidity and mortality through severe urinary tract, bloodstream, and gastrointestinal infections. While conventional antimicrobial susceptibility testing (AST) remains highly reliable, its prolonged incubation periods (18–24 hours) delay critical clinical decisions. This review systematically evaluates and compares traditional methods with rapid phenotypic, molecular, and emerging diagnostic technologies. Our comparative analysis indicates that automated phenotypic systems (e.g., VITEK 2) and MALDI-TOF mass spectrometry substantially accelerate time-to-result, reducing turnaround times to 4–8 hours and <4 hours, respectively, while maintaining over 92% sensitivity. Furthermore, molecular assays like real-time PCR provide ultimate specificity (>99%) within 1–4 hours. Despite challenges such as high initial costs and technical complexity, integrating these rapid diagnostics into clinical workflows is essential for guiding targeted antibiotic therapy, reducing broad-spectrum misuse, and fortifying global antimicrobial stewardship.