Table 1.

Barriers to the development and implementation of improved AST systems^a

Barriers	Effect on patient	Effect on user	Effect on manufacturer	Effect on policy maker
Competence of laboratory personnel		x
Distance between clinicians and diagnosticians		x
High cost of test		x
Continuous availability in the laboratory		x
Lack of clinical outcome studies		x
Costs of clinical studies			x
Costs of development			x
Data management and poor electronic medical records			x
Finding partners (clinicians, laboratory directors, researchers, etc.) for clinical studies			x
Intellectual property challenges associated with multiple innovation			x
Laboratory decentralization and unlinked stewardship teams			x
Lack of appropriate marketing			x
Lack of pre-market commitment			x
Quality and availability of primary materials			x
Policy makers not understanding the development process				x
Issues concerning sample taking	x	x
Specimen accessibility	x	x
Knowledge gaps of physicians or clinicians in the relevance of antimicrobial resistance		x	x
Lack of funding		x	x
Storage, transport and stability of the test		x	x
Sample transport and other logistical issues		x	x
Supply chain failure		x	x
Limited exchange between diagnostic and pharmaceutical companies			x	x
Lack of speed	x	x	x
Test availability	x	x	x
FDA validation and European certification (CE) including differences between countries		x	x	x
Biological hazard		x	x	x
Ethical aspects		x	x	x
Insufficient exchange between the public and private sector		x	x	x
Environmental aspects	x	x	x	x
Health practice behaviour	x	x	x	x
Communication (or lack thereof)	x	x	x	x
Lack of support programmes	x	x	x	x

^aThe table is partially based on a prior key paper in this field⁸¹.