Imaging-Based Approaches for Antibiotic Susceptibility Testing

A variety of innovative image-based models have been developed to further reduce the time to phenotypic antibiotic susceptibility testing (AST), with results comparable in accuracy to traditional AST results. With the increasing clinical demand for rapid AST, various new AST techniques based on optical imaging, micro-channel resonators, and other biosensors have been pursued. With over 10 years of CRO service experience, Creative Biolabs has a team of skilled scientists and a mature technology platform that will work with you for AST of live biotherapeutic product (LBP).

Imaging-Based AST

  • Multiplexed Automated Digital Microscopy (MADM)

MADM is an automated microscope under development to provide rapid identification and AST of clinical samples. It uses a gel filter to separate bacterial cells from clinical samples and an electro-kinetic loading to attach the purified bacterial cells to the surface sensing surface. After surface attachment, the fluorescent in situ hybridization (FISH) probe identifies the bacterial cells within 1 hour, and then the AST is followed. To perform AST, MADM detectes bacterial growth every 10 minutes in the Mueller-Hinton medium. Over time (compared to growth controls), clonal clumps are expanded and measured to generate growth curves and determine susceptibility.

Fully automated multiplex digital microscopy system workflow.Fig.1 Fully automated multiplex digital microscopy system workflow. (Chantell, 2015)

  • Single-cell Morphological Analysis (SCMA)

SCMA uses bright-field microscopy to determine morphologic changes in individual bacterial cells induced by antibiotics and enable rapid AST. The captured images are processed using automatic image processing algorithms to quantify the area and number of growing bacterial cells. The classification algorithm processes several morphological features to generate antimicrobial susceptibility data.

Rapid AST using an emerging imaging based tool.Fig.2 Rapid AST using an emerging imaging-based tool. (Syal, 2017)

Advantages and Disadvantages

Although recently emerging imaging-based AST technologies have greatly reduced the time and comparable accuracy and reasonable reproducibility compared to traditional and commercial methods, there is still a long way to go to meet the current needs of the purpose of low-cost, time-efficient, and user-friendly. These technologies still use a copy-dependency approach with a primary culture step. These dependencies limit the application of imaging-based approaches to slow-growing pathogens. Each novel AST modality has its own merits and limitations. We believe that the recently emerging cost-effective imaging platforms, such as lens-free on-chip wide-field imaging, integrating with the advanced machine or deep learning algorithms are capable of solving the currently available issues soon.

Creative Biolabs has unique R&D expertise to provide the highest quality custom AST services at reasonable prices in the LBP and probiotic industry. Our expert scientists and talented technical support team have got you covered all the way. Please contact us for further discussion.


  1. Chantell, C. Multiplexed automated digital microscopy for rapid identification and antimicrobial susceptibility testing of bacteria and yeast directly from clinical samples. Clinical Microbiology Newsletter. 2015, 37(20): 161-167.
  2. Syal, K.; et al. Current and emerging techniques for antibiotic susceptibility tests. Theranostics. 2017, 7(7): 1795.

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