Behavioral Strategies in Diagnostic Stewardship

Advani, Sonali D.; Claeys, Kimberly

doi:10.1016/j.idc.2023.06.004

Cited by 3 publications

(3 citation statements)

References 87 publications

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“…Furthermore, the relationship between diagnostic and AMS continues to be described, with both disciplines essential for optimal impact on the other [56]. Diagnostic decision-making and associated clinical behavior (e.g., antibiotic prescribing) are deeply rooted in behavioral determinants [57]. The decision to order a test is associated with the clinician's baseline understanding of the pre-test probability of the disease of interest, and increasingly, with severe diseases such as VAP, the fear of missing something important [58][59][60][61].…”

Section: Current State Of Diagnostic Stewardship and Future Directionsmentioning

confidence: 99%

“…Centers should consider using AMS-driven result review, communication with the treating team, and education framing of results to guide therapeutic interventions [46]. While advanced rapid diagnostic tests and stewardship interventions are crucial to improving patient care and demonstrating value, they often fall short of their full potential without using implementation frameworks or understanding barriers to adoption or drivers of behavior [55,57]. Adoption of molecular diagnostics for complex conditions like pneumonia may be initially limited due to increased sensitivity and the concern that it will lead to excessive antimicrobial use.…”

Section: Current State Of Diagnostic Stewardship and Future Directionsmentioning

confidence: 99%

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Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

Walker,

Timbrook,

Hommel

et al. 2024

Diagnostics

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The advent of rapid molecular microbiology testing has revolutionized infectious disease diagnostics and is now impacting pneumonia diagnosis and management. Molecular platforms offer highly multiplexed assays for diverse viral and bacterial detection, alongside antimicrobial resistance markers, providing the potential to significantly shape patient care. Despite the superiority in sensitivity and speed, debates continue regarding the clinical role of multiplex molecular testing, notably in comparison to standard methods and distinguishing colonization from infection. Recent guidelines endorse molecular pneumonia panels for enhanced sensitivity and rapidity, but implementation requires addressing methodological differences and ensuring clinical relevance. Diagnostic stewardship should be leveraged to optimize pneumonia testing, emphasizing pre- and post-analytical strategies. Collaboration between clinical microbiologists and bedside providers is essential in developing implementation strategies to maximize the clinical utility of multiplex molecular diagnostics in pneumonia. This narrative review explores these multifaceted issues, examining the current evidence on the clinical performance of multiplex molecular assays in pneumonia, and reflects on lessons learned from previous microbiological advances. Additionally, given the complexity of pneumonia and the sensitivity of molecular diagnostics, diagnostic stewardship is discussed within the context of current literature, including implementation strategies that consider pre-analytical and post-analytical modifications to optimize the clinical utility of advanced technologies like multiplex PCR.

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Section: Current State Of Diagnostic Stewardship and Future Directionsmentioning

confidence: 99%

Section: Current State Of Diagnostic Stewardship and Future Directionsmentioning

confidence: 99%

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

Walker,

Timbrook,

Hommel

et al. 2024

Diagnostics

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“…Healthcare professionals may determine an antibiotic prescription concurrently with or even prior to definitively diagnosing the patient's condition. Subsequently, participants might adapt the diagnosis to align with the treatment decision, potentially introducing a diagnostic misclassification bias [20].…”

Section: Limitationsmentioning

confidence: 99%

Antimicrobial Agent Use for Urinary Tract Infection in Long-Term Care Facilities in Spain: Results from a Retrospective Analytical Cohort Analysis

Matovelle,

Olivan-Blázquez,

Magallón-Botaya

et al. 2024

Antibiotics

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Urinary tract infections (UTIs) are highly prevalent in long-term care facilities, constituting the most common infection in this setting. Our research focuses on analyzing clinical characteristics and antimicrobial prescriptions for UTIs in residents across nursing homes (NH) in Spain. This is a retrospective analytical cohort analysis using a multifaceted approach based on the normalization process theory to improve healthcare quality provided by nursing staff in 34 NHs in Spain. In this study, we present the results of the first audit including 719 UTI cases collected between February and April 2023, with an average age of 85.5 years and 74.5% being women. Cystitis and pyelonephritis presented distinct symptom patterns. Notably, 6% of asymptomatic bacteriuria cases were treated. The prevalence of dipstick usage was 83%, and that of urine culture was only 16%, raising concerns about overreliance, including in the 46 asymptomatic cases, leading to potential overdiagnosis and antibiotic overtreatment. Improved diagnostic criteria and personalized strategies are crucial for UTI management in NHs, emphasizing the need for personalized guidelines on the management of UTIs to mitigate indiscriminate antibiotic use in asymptomatic cases.

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When antimicrobial stewardship begins with microbiological test requests: the case of asymptomatic bacteriuria

Imlay,

Thorpe,

Vaughn

2024

Current Opinion in Infectious Diseases

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Purpose of review We aim to review the rationale, methods, and experiences with diagnostic stewardship targeted at urinary tract infection (UTI) and related urinary syndromes. Recent findings In the last 18 months, several articles have demonstrated the impact of diagnostic stewardship interventions at limiting inappropriate diagnosis of UTIs or inappropriate antibiotic-prescribing, targeting the urinary tract. Antimicrobial stewardship programs may create and implement interventions at the point of urine test ordering, urine test resulting, or at the point of prescribing antibiotics after results have returned. Specific design and implementation of stewardship interventions depends on context. To maximize their impact, interventions should be accompanied by education and garner buy-in from providers. Summary Diagnostic stewardship can decrease unnecessary antibiotics and inappropriate diagnosis of UTI with multifaceted interventions most likely to be effective. Remaining questions include how to reduce ASB treatment in new populations, such as those with immune compromise, and persistent unknowns regarding UTI diagnosis and diagnostics.

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Behavioral Strategies in Diagnostic Stewardship

Cited by 3 publications

References 87 publications

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

Antimicrobial Agent Use for Urinary Tract Infection in Long-Term Care Facilities in Spain: Results from a Retrospective Analytical Cohort Analysis

When antimicrobial stewardship begins with microbiological test requests: the case of asymptomatic bacteriuria

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