Original Title: Diagnóstico molecular de microorganismos resistentes

Authors' objectives: Antimicrobial resistance (AMR) is a serious public health problem worldwide, given that it makes clinical management more difficult and increases mortality, especially in cases of sepsis or tuberculosis (TB). Despite reductions in antibiotic use in Europe, the prevalence of AMR remains high. The limitations of traditional diagnostic approaches have led to the development of rapid methods, in particular molecular techniques that enable the early identification of pathogens involved and drug resistance-associated genes, allowing treatment optimisation and epidemiological surveillance. Objectives 1) To assess the safety, efficacy and efficiency of the molecular diagnosis of single and/or multidrug-resistant microorganisms for their early detection, through a systematic review (SR) of the scientific evidence and 2) to determine the potential implications of early detection of single and/or multidrug resistance regarding treatment initiation, prognosis, control and/or transmission of the infections caused by these microorganisms.

Authors' results and conclusions: A total of 88 SRs were identified. After updating the search in March 2025 and applying the selection criteria, 32 were finally included. The SRs assessed diagnostic accuracy in most cases, and to a lesser extent, the clinical and economic impact of the molecular techniques of interest. They mainly focused on TB, septicaemia, and certain drug-resistant pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and carbapenemase-producing Enterobacteriaceae. Results indicate that rapid molecular techniques have a high diagnostic accuracy, although there is considerable heterogeneity between studies. The evidence concerning the impact of these techniques on key clinical outcomes, such as mortality, is limited and of low quality. The main benefits found were reductions in time to diagnosis and the optimisation of antibiotic therapy. Economic assessments suggest that these techniques may be cost-effective, especially in cases of septicaemia and TB, although outcomes depend on the healthcare setting. The majority of studies were performed in adults, with limited evidence in children. Conclusions Rapid molecular techniques provide high diagnostic accuracy for detecting single- and/or multidrug-resistant microorganisms in a wide variety of clinical settings. Nonetheless, the evidence of their impact on key clinical outcomes is limited and of low quality. Some studies report decreases in time to administration of appropriate therapy and possible cost-effectiveness, especially in septicaemia; however, the heterogeneity of studies and the scarcity of data in children limit the generalisation of the findings. For this reason, there is a need for further research adapted to our setting.

Authors' methods: An SR was conducted based on searches in specialised and general databases, and brought up to date in 2025. Two independent reviewers selected SRs, meta-analyses and economic assessments on the diagnostic accuracy, efficacy, efficiency and costs of molecular diagnostic methods for AMR for inclusion in the analysis. The risk of bias was assessed with validated tools appropriate to the study design. Data were systematically extracted from the studies, and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/E-26-08-Microorganismos_resistentes.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>