The Revolution of Lateral Flow Assay in the Field of AMR Detection

The global spread of antimicrobial resistant (AMR) bacteria represents a considerable public health concern, yet their detection and identification of their resistance mechanisms remain challenging. Optimal diagnostic tests should provide rapid results at low cost to enable implementation in any microbiology laboratory. Lateral flow assays (LFA) meet these requirements and have become essential tools to combat AMR. This review presents the versatility of LFA developed for the AMR detection field, with particular attention to those directly triggering beta-lactamases, their performances, and specific limitations. It considers how LFA can be modified by detecting not only the enzyme, but also its beta-lactamase activity for a broader clinical sensitivity. Moreover, although LFA allow a short time-to-result, they are generally only implemented after fastidious and time-consuming techniques. We present a sample processing device that shortens and simplifies the handling of clinical samples before the use of LFA. Finally, the capacity of LFA to detect amplified genetic determinants of AMR by isothermal PCR will be discussed. LFA are inexpensive, rapid, and efficient tools that are easy to implement in the routine workflow of laboratories as new first-line tests against AMR with bacterial colonies, and in the near future directly with biological media.

Automated summary

The global spread of antimicrobial resistant bacteria poses a significant public health concern. Detecting and identifying resistance mechanisms is challenging, but lateral flow assays (LFA) have emerged as cost-effective and rapid tools to combat antimicrobial resistance. This review examines the versatility and performance of LFA for detecting antimicrobial resistance, focusing on beta-lactamase triggers. It also discusses potential modifications to broaden clinical sensitivity and improve sample handling processes. Additionally, the use of LFA in detecting amplified genetic determinants of antimicrobial resistance is explored.