Antibiotic resistance: diagnostics is the extra weapon against super bacteria

Antimicrobial resistance (AMR) continues to represent one of the most urgent health threats for our country: this alarming confirmation emerges from the latest data recently released on the occasion of World Antibiotic Awareness Week 2025. Every year in Italy there are about 12,000 deaths associated with infections caused by antibiotic-resistant microorganisms, a number that highlights the urgency of the challenge and the need for targeted policies to reverse the trend.

Combating AMR is not only a public health imperative: it is a prerequisite for safeguarding the National Health Service and the economic sustainability of the entire system. To effectively tackle this silent pandemic, it is a priority to strengthen the prevention and management of infectious diseases, ensure uptake and access to diagnostics and treatments, and implement integrated diagnostic stewardship and antimicrobial stewardship programmes in both hospital and community care settings.

In this context, all available weapons must be deployed, and among these an emerging awareness concerns the recognition and enhancement of the role of laboratory diagnostics. The reason for this is intuitive: if the antibiotic is to be used when an infection is present or suspected, the best possible use of the antibiotic is when a) the infection is diagnosed with certainty, and not just suspected, or b) the infection is ruled out with certainty, and therefore the antibiotic may with equal certainty not be used.

At the international level, a debate has opened on this very issue, shifting the focus from the drug alone (the antibiotic) to the strategy upstream of its prescription (i.e. diagnostic reasoning), recognising the decisive contribution that the innovative diagnostic technologies available today can offer in the global response to AMR. Diagnostics emerges as an essential preliminary step: the only tool capable of rapidly guiding targeted clinical decisions and appropriate use of antibiotics, helping to preserve the efficacy of these essential molecules for future generations.

Leading this reflection was the prestigious Office of Health Economics (OHE), which, with over 60 years of experience, represents the world's oldest independent organisation dedicated to health economics research. A recent publication, developed by an international group of 10 experts - clinicians, health technologyassessment (HTA) representatives, policy-makers and academic health economists from Canada, the United States, Belgium, the United Kingdom, Italy and Switzerland - addressed the issue of the reduced 'performance' of many current health technology assessment (HTA) methods, as these methods do not fully grasp the role of diagnostics as an 'enabling lever', i.e. one that is able to bring out the full potential of antibiotics. In fact, laboratory diagnostics allows, as mentioned above, the identification of cases in which antibiotics are necessary and those in which, on the contrary, they are not.