When Culture Results Don’t Tell the Whole Story: A Practical Review of Antibiotics Pitfalls for Clinical Decision-Making

Antimicrobial susceptibility testing has long served as the cornerstone of infectious disease management, guiding clinicians toward selecting appropriate therapeutic agents. However, an emerging body of evidence demonstrates that blind adherence to culture and sensitivity reports can lead to therapeutic failures, increased mortality, and propagation of antimicrobial resistance. This review critically examines clinical scenarios where conventional antimicrobial susceptibility testing results may be discordant with clinical outcomes, emphasizing the critical importance of integrating microbiological data with pharmacokinetic principles, host factors, and evidence-based guidelines. By understanding the limitations of culture-based testing including intrinsic resistance mechanisms, inducible resistance patterns, site-specific pharmacodynamic considerations, and the distinction between colonization and infection, clinicians can make more informed therapeutic decisions that optimize patient outcomes while preserving the antimicrobial arsenal.