Rapid antimicrobial susceptibility testing in severe bacterial infections: clinical value, implementation barriers and recommendations for Ukraine's healthcare system

Abstract

Background. Severe bacterial infections – including sepsis, pneumonia, bloodstream infections (BSI), surgical site infections (SSI), and complicated urinary tract infections – are leading causes of in-hospital mortality and healthcare expenditure. Each hour of delayed targeted therapy in septic shock reduces survival by 7.6%. Standard blood culture requires 48–72 hours. Rapid AST delivers phenotypic results within 4–8 hours, fundamentally altering management of severe bacterial infections. Objective. To systematise evidence on the clinical value of Rapid AST across severe bacterial infections (sepsis, BSI, pneumonia, SSI, wound infections, complicated UTI); assess implementation barriers in Ukraine; and develop specific clinical, managerial, and financial recommendations. Methods. Systematic review (PubMed, Scopus, WoS; 2020–2026; n=22; PRISMA-ScR); GRADE meta-analysis; MOH Ukraine, CDC/UPHC and WHO data. Results. RDT+AMS reduces 30-day mortality in sepsis/BSI (OR 0.78; 95% CI 0.65–0.93), shortens LOS by 4–7 days across infection types, increases targeted therapy from 41% to 73%, and provides savings exceeding USD 650,000/year. In Ukraine, six systemic barriers identified. Bacteriological testing prior to antibiotics occurs in only 33% of hospitalised patients (MOH 2025); MDR in 84.6% of wound isolates creates a critical diagnostic gap. Conclusions. Rapid AST implementation is clinically justified and financially viable. Twelve specific recommendations (clinical, managerial, financial, military-medical) with target indicators are proposed. Incorporating FAST-AST into NHSU tariffs is the key systemic decision.