Advancing Diagnostic Stewardship for Healthcare-Associated Infections, Antibiotic Resistance, and Sepsis

Abstract

Diagnostic stewardship means ordering the right tests, for the right patient at the right time to inform optimal clinical care. Diagnostic stewardship is an integral part of antibiotic stewardship efforts to optimize antibiotic use and improve patient outcomes, including reductions in antibiotic resistance, and treatment of sepsis. CDC’s Division of Healthcare Quality Promotion (DHQP) hosted a meeting on improving patient safety through diagnostic stewardship with a focus on the use of the laboratory. The meeting identified emerging issues in the field of diagnostic stewardship, raised awareness of these issues among stakeholders, and discussed strategies and interventions to address the issues—all with an emphasis on improved outcomes and patient safety. This white paper summarizes the key takeaways of the meeting including needs for diagnostic stewardship implementation, promising future avenues for diagnostic stewardship implementation, and areas of needed research.

Effects of infectious disease consultation and antimicrobial stewardship program at a Japanese cancer center: An interrupted time-series analysis

“…This is an important finding for the promotion of diagnostic stewardship. Diagnostic stewardship refers to the performing of the appropriate test on the appropriate patient at the appropriate time, to provide optimal clinical care [ 21 ]; it is an integral part of ASP [ 22 ]. At the beginning of our intervention, the ASP was impeded by the insufficient number of specimens submitted; however, as the total number of specimens increased, the ASP could be conducted appropriately.…”

Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool

“…Diagnostic stewardship interventions that provide a swift and personalized blood culture testing approach are urgently needed to reduce the overuse of blood cultures and the serious secondary effects of contamination. 15 We recently demonstrated the feasibility of using electronic health record (EHR) data in a machine learning model to detect patients at low risk of a positive blood culture, in whom blood culture analyses could safely be avoided. 10 However, this model did not lend itself well to external validation and clinical implementation due to the many features included.…”

Outpatient Antibiotic and Antiviral Utilization Patterns in Patients Tested for Respiratory Pathogens in the United States: A Real-World Database Study

“…One aspect of antibiotic stewardship is diagnostic stewardship, ordering the right test to inform timely and appropriate test-guided treatments and improve patient care [ 9 , 10 ]. In the last decade, dozens of highly sensitive molecular-based diagnostic tests for respiratory pathogens have been cleared or approved by the U.S. Food and Drug Administration [ 11 , 12 ].…”