“Clinical judgment alone struggles to reliably distinguish between bacterial, viral, or fungal infections,” said Jeanie Bach, MSN, RN CCRN, senior medical manager for infectious disease at Roche Diagnostics. “For example, because of overlapping clinical symptoms among respiratory viruses, one study showed that only 36% of influenza cases were correctly identified based on symptoms alone, compared with over 98% accuracy when using a rapid PCR test for flu.¹

“Similarly, in urgent care settings relying on symptom-based syndromic management for STIs, 68.8% of patients were overtreated with unnecessary antibiotics, while 8.2% were undertreated,” Bach continued.^1,2 “This uncertainty leads to the reflexive prescribing of broad-spectrum antibiotics. Broad-spectrum drugs act as a "catch-all," disrupting the human microbiota, creating harsher side effects, and further driving the cycle of resistance.”

“Antimicrobial resistance is the hardest area to manage operationally,” said Chris Connelly, PhD, director of business segment, molecular, at Streck. “Molecular methods detect resistance genes quickly, and rapid phenotypic susceptibility testing has started to close the gap from the other side, but the two are answering different questions. A gene result tells you that a known mechanism is present. A phenotype tells you whether the drug will work on that organism, and they don't always line up. Genotypic detection only finds what it's built to look for, so resistance that comes from an untargeted gene variant, reduced permeability from porin loss, or efflux pump overexpression can be missed even when the organism is clearly resistant. 

“As panels add targets and the same chemistry is used for community surveillance, speed stops being the limiting factor,” Connelly added. “The harder problem is confirming the assay still detects every target it's supposed to, which takes characterized control material covering the full set and, for surveillance work, that material mostly doesn't exist yet. A faster result has little value without a consistent way to ensure reliable and accurate test results.”

Dee Scott, MLS (ASCP)^cm, chemistry section head, generalist, laboratory service excellence ambassador for Memorial Hospital in Carthage, IL. commented on the challenges her lab faces in this area – and how they work to overcome them. 

“One of the biggest challenges our laboratory faces related to AMR testing is balancing the need for timely, comprehensive susceptibility results with the resource limitations of a rural critical access hospital. Lower testing volumes, staffing constraints, and limited access to advanced molecular testing platforms can make it difficult to perform the same breadth of AMR testing available in larger reference or tertiary care laboratories.

“To address these challenges, we maintain close collaboration with our reference laboratory partners to ensure access to specialized testing and resistance detection methods when needed. We also work closely with physicians, pharmacists, and infection prevention personnel to promote appropriate culture collection, antimicrobial stewardship, and effective use of susceptibility data. In addition, we continuously monitor updates to testing guidelines and resistance trends to ensure our microbiology practices support accurate and timely patient care while maximizing the resources available to our facility.”

“As respiratory testing demand normalizes, laboratories are shifting from a crisis-response model to a more deliberate, clinically driven strategy,” said  Tsalik. During the pandemic, the priorities were capacity, speed, supply continuity, and rapid reporting. Now, the question is more nuanced: which test provides the most useful answer for a given patient and care setting?”

“Many laboratories are moving toward tiered testing algorithms,” Tsalik continued. “Targeted assays for high-prevalence pathogens such as SARS-CoV-2, influenza, and RSV may be appropriate for routine seasonal illness, while broader multiplex panels can be reserved for patients with severe disease, immunocompromised status, atypical presentations, outbreaks, or situations where broader results will be actionable. Meanwhile, laboratories are rebalancing their infectious disease menus in areas such as STI and viral hepatitis screening, which were deprioritized during the pandemic.”

Respiratory pathogens of concern

Influenza A/B remained the respiratory pathogen most frequently associated with positive test results, cited by 55% of respondents. However, this represents a substantial decline from 2025, when 82% of respondents identified influenza as one of the most common positive findings. 

COVID-19 also showed a notable decline, falling from 63% in 2025 to 32% in the current survey. RSV remained relatively stable at 31%, compared with 33% last year. Other commonly identified pathogens included Strep A/B (19%), rhinovirus (14%), human metapneumovirus (8%), and pneumonia-related infections (9%). Notably, more than one-quarter of respondents (27%) reported they did not know which respiratory pathogens produced the highest number of positive results in their laboratories.

“Laboratories are increasingly adopting both antigen and molecular testing,” said David Morris, PhD, associate director, product management, SEKISUI Diagnostics. “When the clinical presentation aligns with the antigen assay, rapid tests are often used for quick testing results and operational simplicity. In cases where results are negative but clinical suspicion remains high; labs may use molecular testing. The dual testing modality gives labs more flexibility so they can deliver both rapid and reliable diagnoses.”

Medical laboratory supply chain strategies

MLO also asked respondents whether geopolitical factors are affecting their laboratories’ purchasing and inventory management strategies. The majority (81%) reported no impact, compared with 75% in 2025. However, nearly one in five respondents (19%) indicated geopolitical factors are influencing their purchasing decisions.

Among those reporting an impact, common themes included backorders, delayed deliveries, rising costs, tariffs, and supply shortages. Several respondents specifically referenced challenges obtaining products manufactured overseas and concerns regarding reimbursement failing to keep pace with increased supply costs. Others described the need to place orders earlier, increase inventory monitoring, are carefully balance stock availability against expiration risks.

One respondent noted that tariffs and international shipping delays have increased supply costs without corresponding reimbursement increases. Another described weekly ordering becoming necessary because of limited storage capacity and unpredictable supply availability. Others cited ongoing shortages of laboratory disposable media. 

“We have seen customers shift their purchasing strategy from a cost-based approach to a focus on supply chain reliability,” said Morris. “Consistency in laboratory workflows is key for our customers, which is why more are choosing suppliers with products made in the USA.”

Although fewer laboratories reported geopolitical impacts this year than in 2025, the qualitative responses suggest that supply chain resilience remains a priority for many laboratory leaders. Scott commented on her experience:

“Supply chain disruptions, product backorders, rising costs, and other external factors have affected our laboratory's purchasing and inventory management strategies. As a result, we have increased monitoring of inventory levels, adjusted par levels for critical reagents and consumables, and maintained closer communication with vendors regarding product availability and lead times.

“These challenges are amplified by the fact that we are a rural critical access hospital. Unlike larger health systems that may have multiple facilities or centralized supply chains, we often have fewer local resources and less flexibility when critical laboratory supplies are unavailable. Delays in receiving reagents or consumables can have a significant impact on our ability to provide timely testing services to our patients and community.

“To mitigate these challenges, we work collaboratively with neighboring hospitals and laboratory partners to borrow reagents and other essential supplies when shortages occur. Likewise, when supply issues prevent our neighboring hospitals from performing certain tests, our facility assists by performing testing on specimens from their patients. These experiences have required a more proactive approach to inventory management, contingency planning, and regional collaboration to ensure continuity of laboratory operations, maintain quality standards, and support uninterrupted patient care.”

Looking ahead

The 2026 MLO State of the State Industry survey illustrates a laboratory community balancing innovation with operating realities. In antimicrobial resistance testing, laboratories continue to rely heavily on traditional susceptibility testing while exploring opportunities in molecular diagnostics, automation, and rapid testing. At the same time, staffing shortages, and reimbursement pressures remain significant concerns. 

Within respiratory diagnostics, testing demand appears to be stabilizing, while molecular methods continue to drive laboratory decision-making. Laboratories are also expanding awareness of emerging pathogens and evaluating preparedness for future infectious disease threats. 

As healthcare systems continue to confront evolving infectious disease challenges, clinical laboratories remain at the center of efforts to improve patient outcomes, support stewardship initiatives, and strengthen public health surveillance.

References

1. Glasgow KE. Lack of sexually transmitted infection treatment accuracy when relying on syndromic management in an urgent care setting. Sex Transm Dis. 2020;47(9):625-627. doi:10.1097/OLQ.0000000000001216.
2. Hansen GT, Moore J, Herding E, et al. Clinical decision making in the emergency department using rapid PCR: results of the CLADE study group. J Clin Virol. 2018;102:42-9. doi:10.1016/j.jcv.2018.02.013.