Antimicrobial resistance (AMR) is often framed as a hospital problem. That framing is understandable: clinicians and microbiology laboratories see the immediate consequences of resistant infections. However, resistance arises, spreads and is selected for across a far broader set of interfaces. Human health, veterinary care, food production and the environment are linked by organism movement, gene flow and shared selective pressures.
If we want AMR strategies that reduce risk rather than merely document failure, diagnostic insight needs to move upstream. That means detecting resistance determinants earlier, across a wider variety of sample types, and returning reliable results fast enough to shape stewardship, biosecurity and supply-chain risk management.
Resistance genes and resistant organisms do not respect sector boundaries. A resistance determinant selected by antimicrobial use in livestock can be carried on mobile elements into food chains, reach people through food handling or the environment, and re-enter clinical settings. [1] Conversely, resistant strains emerging in hospitals can seed wastewater and agricultural soil.
A One Health diagnostic lens recognises three practical implications. First, surveillance must cover multiple matrices: clinical specimens, faecal material, carcass swabs, wastewater and environmental samples. Second, methods must target both organisms and resistance determinants, because phenotypic resistance and genetic markers offer different but complementary signals. Third, data must be comparable and timely so that stewardship decisions, regulatory responses and on-farm interventions can be coordinated.
Current AMR responses often rely on culture-based testing and ad hoc sampling. Culture remains essential for many purposes, but it has limits for broad surveillance. Culturing takes time, it may miss viable-but-non-culturable organisms, and selective media bias can hide relevant taxa. Fragmented workflows between clinical, veterinary and food laboratories reduce comparability and slow information flow.
Treatment-stage testing is valuable but reactive. By the time culture and susceptibility results are available, an infection may be established and transmission chains advanced. For surveillance, the key questions are different: where are resistance determinants emerging, how are they moving, and which nodes in the system represent the highest risk for spillover. Answering these questions requires faster detection across diverse sample types, plus reproducible methods that perform in complex matrices.
Molecular diagnostics do not replace culture; they complement it. Targeted nucleic acid tests can detect resistance genes and organism-specific signatures directly from many matrices. The practical advantages are clear: speed, sensitivity for low-abundance targets, and the ability to multiplex assays to screen for multiple genes or pathogens in a single run.
PCR and real-time PCR remain workhorse technologies because they are well understood, relatively affordable and scalable. Multiplex panels can screen for common resistance determinants - such as beta-lactamase genes or macrolide resistance markers - alongside species identification markers. When combined with careful assay design and validation, these approaches provide early warning signals that guide targeted culture, epidemiological tracing and stewardship.
Point-of-care testing (POCT) extends that early-warning layer closer to where decisions are made. Loop-mediated isothermal amplification (LAMP) supports POCT because it amplifies nucleic acids at a single, constant temperature, removing the need for complex thermocyclers and enabling compact, low-power instruments. [2] LAMP often produces a detectable signal within tens of minutes and shows relative tolerance to inhibitors found in urine, faeces and many environmental samples, which can allow simpler extraction workflows in some settings. Lyophilised LAMP reagents and straightforward readouts reduce cold-chain demands and operator complexity. These practical advantages make LAMP a useful near-patient screening tool when assays are well designed, include internal controls and sit within a defined workflow that specifies reflex testing and interpretive rules.
Genotypic results require interpretation. Presence of a gene does not always equal clinical resistance, and context matters. That is why molecular outputs should be integrated with phenotypic data where available and used to prioritise investigations rather than to make blanket treatment decisions in isolation.
High-quality molecular results start with sample preparation. Complex matrices -faeces, meat rinse, soil, biofilm, wastewater - contain inhibitors and variable target loads. Effective nucleic acid extraction, inhibitor removal and consistent input volumes are prerequisites for sensitive, reproducible assays. [3]
Workflow design affects data quality and scalability. Key considerations include:
matrix-specific extraction methods that recover nucleic acids reliably across sample types.
validated internal controls to detect extraction failure or PCR inhibition.
standardised protocols that reduce operator variability.
throughput requirements aligned with surveillance goals - batch-based extraction for high-volume screening, and flexible single-sample workflows for targeted investigations.
documentation and traceability to support cross-sector data sharing.
Investment in extraction and preprocessing often yields greater gains than upgrading detection chemistry alone. Poor extraction undermines even the most specific assays; robust sample handling multiplies the value of molecular tests.
A One Health workflow must be modular and practical across contexts. [1]
Food testing. Routine screening of carcass swabs or food-contact surfaces can use validated extraction kits designed for meat matrices, followed by multiplex PCR panels for common resistance genes and indicator organisms. Positive screens trigger targeted culture and whole-genome sequencing when needed for source attribution.
Veterinary screening. On-farm surveillance can combine pooled faecal swabs with simplified extraction workflows and field-deployable PCR instruments for rapid screening. Findings inform targeted stewardship interventions, drug-use audits and biosecurity measures.
Environmental surveillance. Wastewater and surface-water sampling require concentration steps and inhibitor-aware extraction. Molecular screening of sewage can reveal community-level trends in gene prevalence and identify emerging resistance before clinical cases rise.
Clinical interface. Rapid molecular detection of resistance determinants from clinical specimens can shorten time to appropriate therapy. When integrated with upstream surveillance data, clinicians and infection-control teams gain broader situational awareness about circulating resistance profiles.
Across these applications, interoperability matters. Using standardised controls, harmonised reporting formats and agreed interpretive criteria makes data from different sectors comparable and actionable.
Earlier diagnostic signals are only useful if they inform decisions. Practical ways molecular diagnostics support action include:
Stewardship targeting: early detection of an emerging gene in a production system can prompt review of antimicrobial use and targeted interventions.
risk-based sampling: molecular surveillance can guide where to invest limited culture and sequencing resources.
outbreak containment: rapid genotypic screening can prioritise samples for confirmatory testing and contact tracing.
supply-chain risk management: food processors can use screening data to adjust controls or batch release decisions.
policy and regulation: aggregated, standardised data support evidence-based regulation and public-health recommendations.
Crucially, diagnostic data should be presented with clear uncertainty bounds and interpretive guidance. Overconfident, decontextualised results erode trust and can lead to inappropriate actions.
Effective AMR strategies must move beyond reactive, single-sector thinking. Diagnostics that detect resistance earlier, across diverse matrices, and with reproducible workflows are central to a realistic One Health response. Practical gains come from pairing sensitive molecular detection with dependable sample preparation, standardised controls and workflows designed for the sample types and throughput needs of each sector.
Diagnostics are not an end in themselves. They are a tool for stewardship, risk reduction and timely decision-making. Investing in the parts of the workflow that are often overlooked - extraction, inhibitor controls, and process standardization - yields clearer signals and more useful data for action.
Invitek Diagnostics will soon introduce InviDx®, a compact POCT molecular workflow designed to bring earlier AMR insight closer to where decisions are made. InviDx® emphasises ease of use and workflow reliability. The design minimises hands-on steps, uses lyophilised ready-to-use reagents, and pairs automated detection with AI-assisted result interpretation to reduce operator burden and standardise calls across users. These elements are intended to simplify routine screening and shorten the path from sample to a usable result. Speed is a practical priority. InviDx® aims to deliver results in under 60 minutes from sample collection, supported by a rapid extraction module that processes samples in seconds and a multiplexed detection format that screens multiple targets in a single run.
We will share full technical details, validation data and availability dates as the launch approaches. Laboratories or programmes interested in early evaluation, pilot studies or technical briefings may contact us at invitek.com or info@invitek.com to register interest.
1. World Health Organization. Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015. Available from: https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1.
2. Joung Y, Hennessey CM, Kim J, et al. LAMP diagnostics at the point of care: emerging trends and perspectives for the developer community. Expert Rev Mol Diagn. 2021;21(4):413–427. doi:10.1080/14737159.2021.1873769.
3. Sidstedt M, Rådström P, Hedman J. PCR inhibition in qPCR, dPCR and MPS—mechanisms and solutions. Anal Bioanal Chem. 2020;412(9):2009–2023. doi:10.1007/s00216-020-02459-7.