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Antimicrobial resistance (AMR) is a growing challenge in cardiology, turning routine procedures like valve replacements and cardiac device management into ife-threatening risks. Cardiac patients, already vulnerable due to underlying conditions, face an even greater threat as drug-resistant infections rise. Without effective measures, AMR could undo decades of progress in cardiac care. This article examines the challenges and risks of AMR, highlights current initiatives, and explores advancements in diagnostics and emerging trends to improve patient outcomes and shape the future of cardiology.1,2
Antibiotics, since their discovery in 1928,3 have transformed modern medicine, yet their effectiveness is being rapidly undermined by antimicrobial resistance (AMR). Resistance was documented as early as the 1940s, soon after the mass production of penicillin, and has since escalated into a global crisis. Drug-resistant pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria now threaten even routine medical procedures. If left unchecked, AMR is projected to cause 10 million deaths annually by 2050, surpassing cancer as a leading cause of mortality.4
In cardiology, AMR presents specific challenges that increase risks for patients undergoing life-saving procedures such as valve replacements, coronary artery bypass grafting, and implantable cardiac devices, all of which rely on effective infection control. Some of the most pressing concerns include:
Tackling these challenges demands urgent innovation in diagnostics and targeted strategies to protect patient outcomes and the future of cardiac care.5
Efforts from health organisations, researchers, and medical guidelines are shaping strategies to improve antibiotic use and strengthen infection prevention. Global initiatives, clinical studies, and expert recommendations continue to drive best practices in managing AMR in cardiac care.
The World Health Organization (WHO) has published a Global Action Plan on Antimicrobial Resistance15, alongside nation-specific initiatives led by organisations such as the US Centers for Disease Control and Prevention (CDC) and the UK Health Security Agency (UKHSA).16,17 These initiatives provide strategic guidance on raising AMR awareness, reducing antibiotic misuse, strengthening infection prevention, and promoting the development of new medicines and diagnostic tools.
In addition, research in this field has shown that prolonged or unnecessary antibiotic use does not always enhance patient safety and may, in fact, contribute to resistance. For example, Ren et al. identified inappropriate antibiotic exposure as a key factor increasing the risk of multidrug-resistant infections following heart surgery, underscoring the need for stricter antibiotic management.8 Similarly, Hamouda et al. found that reducing antibiotic duration post-surgery did not increase infection risks but helped mitigate resistance and reduce healthcare costs.18 Branch-Elliman et al. also demonstrated that extending prophylactic antibiotic use offered no added safety benefits but instead heightened the risk of adverse effects.19 Additionally, research by Rennert-May et al. showed that post-procedural antibiotics for cardiac device implantation, such as pacemakers, did not prevent infections or improve survival rates, raising concerns about their contribution to resistance.20
Aligning with these findings, the American Heart Association (AHA) recently updated its guidance on Cardiovascular Implantable Electronic Device (CIED) infections, reinforcing that post-procedural antibiotics do not significantly prevent infections.21 Instead, the AHA emphasises on several best practices:
For antibiotics to remain effective, they must be used only when truly necessary, which depends on the ability to quickly and accurately identify infections. Without reliable diagnostics, antibiotics may be prescribed unnecessarily, driving resistance and limiting future treatment options. Given the profound impact of AMR on cardiac patients, integrating advanced diagnostic solutions is essential to enable early infection detection, effectively guide timely infection management, and improve patient outcomes in cardiology care.
In the fight against infections, timely and accurate detection is crucial for effective management and treatment decisions. This section explores the competitive landscape, focusing on two key areas: laboratory diagnostics and point-of-care (POC) testing.
| laboratory diagnostics | point-of-care (POC) testing | |
| Description | Diagnostic tools used in centralised laboratories that provide detailed and accurate pathogen and resistance analysis, ideal for large-scale operations and comprehensive testing. | Portable and rapid diagnostic solutions used near the patient to provide fast results, supporting immediate clinical decisions in decentralised or resource-limited settings. |
| Pros | -High accuracy and detailed pathogen/resistance analysis -Suitable for large-scale operations in hospitals and research facilities -Comprehensive testing capabilities, including AST | – Rapid results (as fast as 15-90 minutes), enabling timely treatment decisions – Portable and user-friendly, ideal for small clinics and resource-limited settings – Supports antibiotic stewardship by reducing unnecessary antibiotic prescriptions |
| Cons | – Requires skilled personnel and dedicated laboratory infrastructure – Longer turnaround times (several hours to days) – High costs for initial setup and maintenance | – Limited pathogen coverage in many systems – Some systems lack antibiotic susceptibility testing (AST) functionality, limiting personalised treatment options |
Laboratory-based diagnostics are the foundation of infection detection, providing detailed and accurate analysis of pathogens and resistance patterns. Major companies like Thermo Fisher provide a wide range of molecular diagnostics platforms, automated systems, and essential reagents. These solutions help hospitals and research facilities identify antimicrobial resistance, making them ideal for large-scale operations.22
Other companies, including bioMérieux, Accelerate Diagnostics, Karius, and BD, have also made significant strides in AMR detection. For instance, bioMérieux’s VITEK® and BIOFIRE® systems deliver advanced pathogen identification, while Accelerate Diagnostics’ Pheno® System focuses on rapid antibiotic susceptibility testing (AST). However, most of these platforms require skilled personnel and laboratory settings, limiting their applicability in POC environments.23,24,25,26
POC testing is becoming a crucial tool in the fight against AMR, allowing for faster diagnostics at the patient’s bedside. Unlike traditional laboratory diagnostics, which require specialised infrastructure and have longer turnaround times, POC devices are portable, easy to use, and deliver results within minutes. This makes them particularly valuable in emergency settings, resource-limited environments, and outpatient care, where immediate treatment decisions are essential.
The use of POC testing is expanding because of its role in antibiotic stewardship. By quickly distinguishing bacterial from viral infections, it helps reduce unnecessary antibiotic prescriptions. Ongoing advancements in speed, accuracy, and accessibility continue to enhance its impact, making it a key strategy for controlling AMR.
| Feature | LumiraDx | Abbott ID NOW™ | Sysmex Astrego | Cepheid GeneXpert® |
 |  |  |  | |
| Type of Detection | Inflammation biomarkers, viral respiratory pathogens | Rapid pathogen identification | Phenotypic Antibiotic Susceptibility Testing (AST) | Molecular diagnostics (PCR-based) |
| Speed of Results | ~15 minutes | ~15 minutes | 30 minutes | ~1 hour |
| Detection Focus | Inflammation biomarkers, viral respiratory pathogens, and coagulation markers | Viral respiratory pathogens and bacterial (i.e. Strep A) | Antibiotic susceptibility testing (AST) | Bacteria, viruses, fungi, and genetic resistance markers |
| Key Use Cases | Ruling out bacterial infections, reducing antibiotic prescriptions | Ruling out bacterial infections, reducing antibiotic prescriptions | Identifying antibiotic susceptibility for personalised treatments | Hospital and surgical settings |
| Footprint size | Small, compact, and portable | Small and compact | Small and compact | Varying sizes from medium to big |
Several key players have developed innovative solutions in this space, each addressing specific needs in infection detection. Notable companies include LumiraDx, Abbott, Sysmex Astrego, and Cepheid:
Each of these players brings distinct strengths to the POC testing market, addressing different aspects of infection detection and management. Some systems, like Sysmex Astrego, focus on antibiotic susceptibility testing (AST) for targeted treatment, while others, like LumiraDx and Abbott, simplify diagnostics to support antibiotic stewardship by distinguishing bacterial from viral infections. However, while POC tests provide rapid results, they often lack the broad sensitivity and pathogen coverage of laboratory-based systems, which can affect clinical decisions in complex infections.
The diagnostic market is advancing rapidly, with innovations focusing on speed, usability, and cost-effectiveness. These improvements have driven adoption in diverse environments, including clinics and hospitals, as well as resource-limited settings. A prominent trend is the emphasis on rapid diagnostics, with most POC testing devices now capable of delivering results within 10–90 minutes, which supports timely treatment and enhanced infectious disease surveillance.31 Future developments will likely revolve around AI-powered diagnostics and seamless data integration, further enhancing AMR identification at the point of care.
Diagnostic testing is critical for tackling antimicrobial resistance (AMR) and improving patient outcomes in cardiology. However, several key challenges must be addressed to enable wider adoption.
One major challenge is seamless integration into existing cardiology workflows. Many diagnostic tools add extra steps to already time-sensitive and resource-intensive care, making implementation difficult. To improve workflow, diagnostic tools should be rapid, portable, and easy to use, with standardised data formats that connect smoothly to broader healthcare systems.
Another challenge is regulatory approval. Diagnostic device regulations vary significantly across regions, making global adoption complex and slowing market entry. A clear understanding of regional requirements and clinical performance standards is key to overcoming these barriers and accelerating access.
Finally, adoption often depends on a diagnostic tool’s perceived value, both in clinical effectiveness and cost. Strong evidence must show that diagnostics reduce hospital stays, prevent unnecessary antibiotic use, and improve patient outcomes. Integrating these findings into health technology assessments can help decision-makers evaluate cost-effectiveness and support investment in new diagnostic solutions.
After extensive development and research in diagnostic devices, companies must focus on effective implementation and tracking progress to ensure successful market adoption of diagnostic devices. Sector & Segment has a strong track record of helping companies navigate this complex and fragmented market. We use diverse research methods to map the competitive landscape, assess market potential, and understand the needs and preferences of key stakeholders. Our experts can support your company by:
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