Diagnostic-Guided Antimicrobial Stewardship: From Pathogen and Host Biology to Clinical Decision-Making

Infectious disease management is shifting toward precision approaches, where the choice, timing, and dose of therapy depend on what a diagnostic test reveals about the pathogen, the host response, and the mechanism of drug action. Diagnostics sit at the center of this shift: by identifying resistance determinants, virulence factors, or host biomarkers, they let clinicians match anti-infective therapy to the biology of the infection rather than treating empirically. This is especially urgent for antimicrobial resistance (AMR), where diagnostic-guided stewardship is one of the few levers that can preserve the effectiveness of existing drugs while new ones are developed.Realizing this potential requires connecting two levels of evidence that are too often reported separately. The first is the microbiological and immunological basis of the test itself: which resistance mechanisms, virulence traits, or host-response signatures a diagnostic detects, how reliably they map onto the infecting organism’s behaviour, and what they can and cannot predict about treatment response. The second is clinical performance: whether assays validated on these markers actually change prescribing, improve patient outcomes, and reduce selective pressure in real-world settings. Bridging the two is what turns a promising marker into a usable stewardship tool.Recent experience, from the COVID-19 pandemic to ongoing AMR containment efforts, has shown how quickly diagnostic capability becomes the rate-limiting step in an infectious disease response, but no single event is this Topic’s rationale. By bringing together microbiologists, immunologists, infectious disease clinicians, and diagnostics researchers, this Research Topic aims to build a cohesive evidence base linking pathogen and host biology to diagnostic-guided antimicrobial decision-making.Proposed themes include, but are not limited to:• Pathogen biology and host response markers that underpin diagnostics for anti-infective therapy selection• Molecular and phenotypic detection of resistance determinants, and how well genotype predicts treatment failure• Host-response biomarkers distinguishing bacterial, viral, and fungal infection, or infection from colonization• Biomarker discovery, analytical validation, and clinical performance evaluation of diagnostics guiding anti-infective use• Rapid and point-of-care microbiological diagnostics for antimicrobial decision-making, including implementation in resource-limited settings• Metagenomic and culture-independent approaches to pathogen identification and susceptibility prediction• Clinical outcome studies and real-world evidence linking diagnostic-guided therapy to treatment success and resistance containment• Diagnostic stewardship in specific clinical syndromes: sepsis, respiratory infection, bloodstream and device-associated infection Topic editors: Miha Skvarc, Samo Jeverica Source: https://www.frontiersin.org/research-topics/84465/diagnostic-guided-antimicrobial-stewardship-from-pathogen-and-host-biology-to-clinical-decision-making