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

Emergence of Antimicrobial Resistance (AMR)

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

How AMR Impacts Cardiology: Challenges and Risks

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:

• Increased risk and complication from AMR infections – Patients undergoing surgical procedures are already facing a heightened risk of infection. When these infections are caused by resistant pathogens, treatment becomes significantly more challenging, often requiring more aggressive interventions with uncertain outcomes.^8,9,10
• Prolonged Hospital Stays – Infections with resistant pathogens often necessitate longer hospitalisations due to the need for complex and extended treatment regimens, thereby increasing healthcare costs and resource utilisation.¹¹
• Limited Antibiotic Options – As we have briefly covered earlier, for patients with AMR-related infections, effective antibiotics may be limited. This could lead to delayed, inadequate, or reliance on toxic treatment, ultimately leading to poorer outcomes and quality of life for the patients.¹²
• Higher Mortality Rates – The combination of delayed effective treatment and the severity of infections caused by AMR leads to a marked increase in mortality rates for cardiac patients.^13,14

Tackling these challenges demands urgent innovation in diagnostics and targeted strategies to protect patient outcomes and the future of cardiac care.⁵

The Critical Role of Diagnostics in AMR: Guiding Infection Management and Responsible Antibiotic Use in Cardiology

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.

Global Health Organisation Initiatives

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.

Key Research Findings on Antibiotic Use in Cardiology

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

Recent Guidelines

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:

• specific infection prevention and control practices,
• timely infection management, and
• early infection detection

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.

Detecting AMR: Current Landscape and Emerging Trends

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 Solutions

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

Point-of-Care Testing

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:

1. LumiraDx
   • Known for its small footprint and rapid testing ability, LumiraDx provides results for inflammation biomarkers and viral respiratory pathogens in about 15 minutes. While it does not offer AST functionality, it aids in ruling out bacterial infections, reducing unnecessary antibiotic prescriptions and indirectly contributing to AMR management.²⁷
2. Abbott
   • The ID NOW™ system provides rapid pathogen identification in under 15 minutes. Although its application is currently limited to a narrow set of pathogens and lacks AST capabilities, it stands out for its ease of operation, compact design, and speed, making it suitable for small clinics or decentralised settings.²⁸
3. Sysmex Astrego
   • The PA-100 AST System specialises in rapid phenotypic Antibiotic Susceptibility Testing (AST), delivering results within 30 minutes. This allows healthcare providers to offer personalised treatments during the patient’s first consultation. Its user-friendly design, affordability, and speed have earned it recognition, including the UK Longitude Prize on AMR.²⁹
4. Cepheid
   • The GeneXpert® System is a molecular diagnostic platform designed to identify pathogens (e.g., bacteria, viruses, fungi) and detect genetic resistance markers, such as MRSA. While its testing time of approximately one hour is slower compared to some POC systems, its broad pathogen detection capabilities make it highly valuable in hospital and surgical settings, particularly in cardiology.³⁰

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.

Key Challenges in Adopting Diagnostic Testing for Cardiology

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.

How We Can Help

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:

• Conducting comprehensive market analyses to evaluate market potential, assess the competitive landscape, and navigate regulatory considerations
• Performing feasibility studies and financial analyses to estimate ROI and guide strategic decision-making
• Quantifying and analysing the preferences of HCPs and payers to determine which product features should be prioritised in product development and marketing
• Designing customised strategic plans that align with your company’s vision, driven by actionable, data-based insights

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