Transforming diagnostic capacity by syndromic infection testing for remote isolated communities.

ObjectiveMany of the UK overseas territories are small with limited microbiological diagnostic capacity for pathogens and antimicrobial resistance detection. The Covid-19 pandemic highlighted the particular vulnerability of these territories for the emergence of novel infections and antimicrobial resistance. MethodsThe UKHSA program with its territory partners implemented rapid automated syndromic molecular diagnostics (RASM), aiming to improve diagnostic capacity. Local laboratory staff were trained in the use of the diagnostics, and guidance was provided to clinicians for requesting tests. Syndromic diagnoses included enteric, respiratory, bloodstream, neurological infection, and antibiotic resistance mechanisms. Data on diagnostic capacity, turnaround times and clinical impact were collected from records before and after implementation of RASM. ResultsTurnaround time for results went from an average 14 days to 1 day, and often much shorter. Previously undiagnosed conditions, could now be identified to the microbiological level rapidly in territory, allowing appropriate specific clinical management, infection prevention, improved antimicrobial stewardship and rapid public health response. This technology is simple to operate and maintain with little scope for user error. The speed of microbiological diagnosis for patient management and public health detection and response was greatly enhanced. ConclusionRapid microbiological diagnosis on site transformed patient management, the timely investigation and management of outbreaks and clusters, accurate surveillance and antimicrobial stewardship. Targeted RASM is cost effective, reducing the requirement for highly trained scientific staff and expensive logistics around rapid transport to reference laboratories. This innovation improves clinical care and strengthens local preparedness in communicable disease and public health response.