Multidrug-resistant (MDR) uropathogenic Escherichia coli (UPEC) remains the leading cause of complicated urinary tract infections (UTIs) and represents a significant threat to effective clinical management. Conventional culture-based diagnostics are limited by prolonged turnaround times, often resulting in delayed targeted therapy and inappropriate empiric antibiotic use. Rapid molecular in vitro diagnostic (IVD) platforms have emerged as a promising solution, enabling early pathogen identification and detection of key antimicrobial resistance (AMR) determinants directly from urine specimens. This review summarizes current evidence on the clinical, technological, and economic impact of rapid molecular diagnostics for MDR UPEC. Multiple studies demonstrate strong concordance between genotypic resistance markers and phenotypic susceptibility for major mechanisms such as extended-spectrum β-lactamases and carbapenemases, with time to appropriate therapy reduced from days to hours. These gains support improved patient outcomes, enhanced antimicrobial stewardship, and reduced healthcare utilization. However, important limitations persist. Molecular assays cannot fully capture the expanding diversity of resistance mechanisms, and genotype–phenotype discordance remains a challenge for resistance mediated by regulatory mutations, efflux systems, porin alterations, or low-level gene expression. Consequently, molecular diagnostics should complement rather than replace phenotypic susceptibility testing. Implementation barriers, particularly in low- and middle-income countries, include high costs, infrastructure requirements, supply chain limitations, and workforce constraints—concerns that are especially critical given the disproportionate MDR UPEC burden in these settings. Future directions include expanded resistome panels, decentralized and point-of-care molecular platforms, phenotype–genotype integration using advanced analytics, and linkage with digital AMR surveillance systems. In conclusion, rapid molecular diagnostics represent a pivotal advancement in MDR UPEC detection and UTI management. Their strategic integration into clinical workflows and surveillance frameworks will be essential to maximize clinical benefit and support global antimicrobial resistance containment efforts.
Abhivant Trupti*1, Chavan Sharvari2, Pachore Aishwarya3, Sulgudle Shivraj4, Dr. Gejage Santosh5 (Sun,) studied this question.