Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

Abstract

Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.

Collaborative Antimicrobial Stewardship

“…All phases of the diagnostic effort, the preanalytical phase, the analytical phase, and postanalytical phase, are critical elements of the testing process because they significantly impact diagnostic accuracy and the antimicrobials prescribed in response to test results. 38 Overuse of unnecessary testing increases the likelihood of false-positive test results that may lead to erroneous diagnoses and inappropriate antibiotic usage. Therefore, the ASP and microbiology laboratory must collaborate to design diagnostic stewardship processes aimed at achieving collective goals.…”

Clinical impact of colonization with multidrug‐resistant organisms on outcome after allogeneic stem cell transplantation in patients with acute myeloid leukemia

“…45,46 For instance, prophylaxis with fluoroquinolones, which are used routinely during AML induction at our center, is associated with the occurrence of MDRO. 50 Furthermore, prospective studies are needed to clarify the association of intestinal microbiota, MDRO colonization, and patient outcomes. 49 In addition, the use of reserve antibiotics might be limited if they are under the control of an antibiotic stewardship program.…”

“…49 In addition, the use of reserve antibiotics might be limited if they are under the control of an antibiotic stewardship program. 50 Furthermore, prospective studies are needed to clarify the association of intestinal microbiota, MDRO colonization, and patient outcomes.…”

Imminent threat of antibiotic resistance and the importance of diagnostic and antibiotic stewardship

“…As the time passed by, we know that the problem is not only related to underdosage but also to other aspects of inappropriate use of antibiotics such as unnecessary use (for example when the infection is due to a virus), and extended duration of antibiotics. (2) The danger of resistance is imminent. In less than 20 years, extended spectrum beta-lactamase (ESBL), i.e.…”