Rapid Antimicrobial Susceptibility Testing (AST): Overview of New Commercially Available Automated Phenotypic Tools for Minimum Inhibitory Concentration (MIC) Determination

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This work addresses a very current and important issue: rapid antimicrobial susceptibility testing (AST), particularly in the context of increasing antibiotic resistance. From the outset, it's clear that the authors understand the importance of the topic well. The text emphasizes the impact of time to results on treatment efficacy and patient prognosis. The broad scope of the work is also a plus. The authors describe both traditional methods (e.g., BMD, disk diffusion) and modern automated systems, as well as the latest developments (e.g., QuickMIC, FASTinov). This provides the reader with a comprehensive overview of the development of AST methods, from reference standards to innovative technologies. The comparative analyses (particularly visible in the tables and supplementary material) are also of great value. The collected data on MIC testing times, result consistency (EA, CA), and the range of applications of individual systems are very useful and well-organized. For example, it clearly demonstrates that new methods can shorten testing times to as little as several hours, which is of great importance in clinical practice.

Despite these strengths, the work also has some weaknesses. First and foremost, this review is descriptive rather than critical. The authors cite numerous research results but rarely analyze them in depth. A good example is the section on discrepancies in results for certain antibiotics (e.g., meropenem or piperacillin/tazobactam), this issue is mentioned but not elaborated on. The following questions remain unanswered: what causes these differences? How might they impact clinical decisions? Are they acceptable in practice? Another issue is the lack of a clearly described literature review methodology. It is unclear what criteria were used to select publications or whether the review was systematic. It would be worthwhile, for example, to add a short description or a subsection describing the search strategy (databases, keywords, year range). The discussion of the practical aspects of implementing the discussed methods also needs improvement. The authors focus primarily on technical parameters, with little attention to costs, availability, or equipment requirements. There is also a certain inconsistency in the level of detail described in the individual methods. Some technologies (e.g., VITEK) are described quite extensively, while others are treated more briefly. It would be beneficial to standardize the structure of the descriptions, for example, by discussing each method according to the same structure: principle of operation, time, scope, limitations.

This article is a valuable and necessary study that effectively organizes current knowledge on rapid AST methods. Its greatest strengths are its timeliness, broad scope, and clear data compilations. Key elements requiring improvement include a deeper critical analysis, a more precise review methodology, and a broader consideration of practical aspects. These changes would enhance the work's scientific and applied value.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a comprehensive review of the commercialized tools for MIC determination for rapid antimicrobial susceptibility testing. Authors compared five rapid phenotypic AST platforms, Vitek® Reveal™, Q-linea ASTar, Fastinov® AST, QuickmMIC®, and Accelerate Pheno® System, which addresses an important gap in clinical microbiology practice.

However, the review currently reads more as a descriptive summary of published data. It can benefit from adding more critical evaluation, like what the performance data mean in practical terms and how the limitations of each system affect real-word application.

 

Line 46. Italicize bacterial species names throughout.

Line 49. Clarify the distinction between attributable to or associated with AMR.

Line 118. It would be better to include more information in table 1, like the pros and cons, or turnaround time of listed manual tests and automated commercial platforms.

Line 191. Please clarify regulatory status (e.g., FDA approval vs CE-IVD), where applicable.

Line 294. Define all abbreviations (e.g., ID, AST, MIC, TAT) in table footnotes and apply consistently across all tables.

Lines 344 – 399. Avoid repeating what a table has already presented. Consider reducing redundancy and focusing the text on interpretation. Same for Table 4, 5, 6, 7.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript “Rapid Antimicrobial Susceptibility Testing (AST): overview of innovative and automated phenotypic tools for Minimum Inhibitory Concentration (MIC) determination” is devoted to commercially available platforms for rapid AST. In my opinion, the review requires substantial revision before it can be considered suitable for publication.

Comments:

1. The title is misleading. In its current form, it suggests that the review covers innovative tools, whereas the manuscript mainly summarizes well-established commercial platforms. It relies largely on outdated scientific publications and technical descriptions of existing commercial systems, while providing little to no overview of currently emerging AST methods that are actively discussed in recent literature. As a result, the manuscript reads more like a practical guide for selecting commercial systems than a critical scientific review. Even in that context, it lacks consistency, as it is overloaded with lengthy descriptive passages on classical MIC determination protocols.
2. In addition to revising the overall scope and organization of the manuscript to better match the title, the Introduction should explicitly describe the review methodology, including scope, inclusion and exclusion criteria, and source selection strategy. It should also include a concise overview of previous reviews in this field, together with a clear explanation of the originality, novelty, and significance of the present account.
3. In my opinion, the scientific merit of a review focused exclusively on currently available commercial platforms is rather limited. To provide meaningful context and broader relevance, the manuscript should compare these established systems with emerging AST technologies currently described in the literature. Such comparison would help readers better understand the present limitations of commercial tools and identify promising directions for future development.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks for the revision. I would still suggest revising Lines 372 -413 as they are highly overlap with Table 3.

Reviewer 3 Report

Comments and Suggestions for Authors

The revised version of the manuscript addresses my comments adequately and can be considered for publication.