{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:47:55Z","timestamp":1791002875374,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FIND"},{"DOI":"10.13039\/501100000276","name":"UK Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024399","name":"Global AMR Innovation Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100024399","id-type":"DOI","asserted-by":"publisher"}]},{"name":"One Health UK aid fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limited diagnostic access in resource-limited settings contributes to poor health outcomes among bacterial sepsis patients and the spread of antimicrobial resistance (AMR). Molecular diagnostic profiling of AMR may enable faster targeting of antibiotic therapies, improving clinical outcomes, reducing AMR development, and saving costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We modeled the impact of a culture-dependent molecular test for pathogen identification and resistance testing among hospitalized bloodstream infection patients to guide effective and cost-efficient implementation of these tools. We evaluated patient mortality, antibiotic use, hospital-associated infections, hospital days, and costs under the standard of care (empiric therapy, blood culture, phenotypic susceptibility testing) compared with molecular diagnostics by varying culture and susceptibility testing coverage, culture turnaround time, and AMR prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The greatest impact of the molecular test occurred with 100% diagnostic coverage, shorter culture turnaround time, and high AMR prevalence, reducing up to 6% of deaths (interquartile range [IQR], 0%\u201312.1%), 5% of hospital days (IQR, 0.1%\u201310.7%), and 21% of days on inappropriate antibiotic therapy (IQR, 18.2%\u201324.4%). The minimum cost per molecular test performed, offset by cost savings, ranged from $109 in India to $585 in South Africa across all modeled scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In high AMR burden settings with blood culture infrastructure supporting fast turnaround times, a molecular test could improve health outcomes of bloodstream infection. Impact is limited by delayed turnaround times and the effectiveness of empiric therapy. Molecular diagnostics implemented at $100 or less can generate healthcare-system cost savings, supporting their adoption to improve health outcomes and reduce AMR while remaining cost-neutral.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf236","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T08:18:32Z","timestamp":1746778712000},"page":"25-32","source":"Crossref","is-referenced-by-count":5,"title":["Modeling the Impact and Cost of a Culture-Dependent Molecular Test for Antimicrobial Resistance in Resource-Limited Settings"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8873-6669","authenticated-orcid":false,"given":"Joshua M","family":"Chevalier","sequence":"first","affiliation":[{"name":"Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan A","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3227-4941","authenticated-orcid":false,"given":"Benjamin","family":"Blumel","sequence":"additional","affiliation":[{"name":"AMR Programme, FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4584-9708","authenticated-orcid":false,"given":"Veronicah","family":"Chuchu","sequence":"additional","affiliation":[{"name":"AMR Programme, FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitta","family":"Gleeson","sequence":"additional","affiliation":[{"name":"AMR Programme, FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Ferreyra","sequence":"additional","affiliation":[{"name":"AMR Programme, FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7247-4190","authenticated-orcid":false,"given":"Shaukat","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Impact, FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":false,"given":"Brooke E","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Impact, FIND , Geneva ,","place":["Switzerland"]},{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts ,","place":["USA"]},{"name":"Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2319-5010","authenticated-orcid":false,"given":"Kyra H","family":"Grantz","sequence":"additional","affiliation":[{"name":"Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Impact, FIND , Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"2026020904070246800_ciaf236-B1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"The Lancet"},{"key":"2026020904070246800_ciaf236-B2","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050","volume":"404","author":"GBD 2021 Antimicrobial Resistance Collaborators","year":"2024","journal-title":"The Lancet"},{"key":"2026020904070246800_ciaf236-B3","doi-asserted-by":"crossref","first-page":"3903","DOI":"10.2147\/IDR.S234610","article-title":"Antimicrobial resistance: implications and costs","volume":"12","author":"Dadgostar","year":"2019","journal-title":"Infect Drug Resist"},{"key":"2026020904070246800_ciaf236-B4","author":"McDonnell"},{"key":"2026020904070246800_ciaf236-B5","volume-title":"Sepsis management in resource-limited settings","author":"D\u00fcnser","year":"2019"},{"key":"2026020904070246800_ciaf236-B6","author":"O\u2019Neill"},{"key":"2026020904070246800_ciaf236-B7","author":"MAAP"},{"key":"2026020904070246800_ciaf236-B8","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1164\/rccm.201609-1848OC","article-title":"The timing of early antibiotics and hospital mortality in sepsis","volume":"196","author":"Liu","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2026020904070246800_ciaf236-B9","author":"World Health Organization"},{"key":"2026020904070246800_ciaf236-B10","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/cid\/ciac727","article-title":"Association between time to appropriate antimicrobial treatment and 30-day mortality in patients with bloodstream infections: a retrospective cohort study","volume":"76","author":"Van Heuverswyn","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026020904070246800_ciaf236-B11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3389\/fmed.2019.00131","article-title":"Best practices of blood cultures in low- and middle-income countries","volume":"6","author":"Ombelet","year":"2019","journal-title":"Frontiers in Medicine"},{"issue":"Suppl 2","key":"2026020904070246800_ciaf236-B12","doi-asserted-by":"crossref","first-page":"S299","DOI":"10.1093\/ofid\/ofz360.719","article-title":"651. Multi-center evaluation of the BioFire\u00ae FilmArray\u00ae blood culture identification 2 panel for the detection of microorganisms and resistance markers in positive blood cultures","volume":"6","author":"Lu","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"2026020904070246800_ciaf236-B13","first-page":"1091","article-title":"Intensive care in India in 2018\u20132019: the second Indian intensive care case mix and practice patterns study","volume":"25","author":"Divatia","year":"2021","journal-title":"Indian J Crit Care Med"},{"key":"2026020904070246800_ciaf236-B14","first-page":"DC01","article-title":"Antimicrobial resistance surveillance among intensive care units of a tertiary care hospital in south India","volume":"11","author":"Moolchandani","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"2026020904070246800_ciaf236-B15","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1186\/s12879-017-2383-z","article-title":"Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis","volume":"17","author":"Zilberberg","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2026020904070246800_ciaf236-B16","author":"World Health Organization"},{"key":"2026020904070246800_ciaf236-B17","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.amjms.2018.11.009","article-title":"Impact of delayed appropriate antibiotic therapy on patient outcomes by antibiotic resistance status from serious gram-negative bacterial infections","volume":"357","author":"Bonine","year":"2019","journal-title":"Am J Med Sci"},{"key":"2026020904070246800_ciaf236-B18","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jiac.2017.11.011","article-title":"Association between appropriate empiric antimicrobial therapy and mortality from bloodstream infections in the intensive care unit","volume":"24","author":"Yamaga","year":"2018","journal-title":"J Infect Chemother"},{"key":"2026020904070246800_ciaf236-B19","first-page":"143","article-title":"Unit costs of inpatient days in district hospitals in South Africa","volume":"48","author":"Olukoga","year":"2007","journal-title":"Singapore Med J"},{"key":"2026020904070246800_ciaf236-B20","doi-asserted-by":"crossref","first-page":"35","DOI":"10.7196\/SAMJ.2018.v109i1.13268","article-title":"Cost of intensive care services at a central hospital in South Africa","volume":"109","author":"Mahomed","year":"2018","journal-title":"South Afr Med J"},{"key":"2026020904070246800_ciaf236-B21","doi-asserted-by":"crossref","first-page":"e69728","DOI":"10.1371\/journal.pone.0069728","article-title":"Unit cost of medical services at different hospitals in India","volume":"8","author":"Chatterjee","year":"2013","journal-title":"PLoS One"},{"key":"2026020904070246800_ciaf236-B22","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1017\/S0266462316000398","article-title":"Cost of intensive care in India","volume":"32","author":"Peter","year":"2016","journal-title":"Int J Technol Assess Health Care"},{"key":"2026020904070246800_ciaf236-B23","doi-asserted-by":"crossref","first-page":"e0225999","DOI":"10.1371\/journal.pone.0225999","article-title":"On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients","volume":"14","author":"Schwarzenbacher","year":"2019","journal-title":"PLoS One"},{"key":"2026020904070246800_ciaf236-B24","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jinf.2014.05.005","article-title":"Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant gram-negative bacteremia","volume":"69","author":"Perez","year":"2014","journal-title":"J Infect"},{"key":"2026020904070246800_ciaf236-B25","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1001\/jama.2017.17687","article-title":"Enhancing recovery from sepsis: a review","volume":"319","author":"Prescott","year":"2018","journal-title":"JAMA"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaf236\/63143414\/ciaf236.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/1\/25\/63143414\/ciaf236.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/82\/1\/25\/63143414\/ciaf236.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T09:07:12Z","timestamp":1770628032000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/82\/1\/25\/8128606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,5,12]]},"published-print":{"date-parts":[[2026,2,9]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaf236","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1,15]]},"published":{"date-parts":[[2025,5,12]]}}}