Diagnostic stewardship based on patient profiles: differential approaches in acute versus chronic infectious syndromes

Tiseo, Giusy; Arena, Fabio; Borrè, Silvio; Campanile, Floriana; Falcone, Marco; Mussini, Cristina; Pea, Federico; Sganga, Gabriele; Stefani, Stefania; Venditti, Mario

doi:10.1080/14787210.2021.1926986

Cited by 7 publications

(8 citation statements)

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“…FDA recently approved the use of dalbavancin, oritavancin, tedizolid and delafloxacin in the treatment of ABSSSIs. 48,49 Recently, the use of long-acting antibiotics became a new therapeutic approach, which allows to treat systemic infections in an outpatient setting. 50 F I G U R E 1 Factors that can influence the microenvironment.…”

Section: How To Treat Complex Woundsmentioning

confidence: 99%

“…FDA recently approved the use of dalbavancin, oritavancin, tedizolid and delafloxacin in the treatment of ABSSSIs. 48 , 49 …”

Section: Introductionmentioning

confidence: 99%

“…In these cases, current guidelines focus the attention on the need of antibiotics with a broad spectrum for the Gram‐positive bacteria, especially MRSA. FDA recently approved the use of dalbavancin, oritavancin, tedizolid and delafloxacin in the treatment of ABSSSIs 48,49 …”

Section: Introductionmentioning

confidence: 99%

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What COVID‐19 taught us: New opportunities and pathways from telemedicine and novel antiseptics in wound healing

Scalise

Falcone

Avruscio

et al. 2021

International Wound Journal

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The COVID‐19 pandemic deeply impacted the capacity of the health systems to maintain preventive and curative services, especially for the most vulnerable populations. During the pandemic, the wound healing centres in Italy assisted a significant reduction of the frequency of their hospital admission, since only urgencies, such as severe infections or wound haemorrhagic complications, were allowed to the hospital. The aim of this multidisciplinary work is to highlight the importance of a new pathway of wound care with patient‐based therapeutic approach, tailored treatments based on the characteristics of the wound and fast tracks focused on the outpatient management, reserving hospital assessment only for patients with complicated or complex wounds. This analysis highlights the point that patients with chronic wounds need to be critically evaluated in order to find the best and most appropriate care pathway, which should vary according to the patient and, especially, to the characteristics of the wound. Moreover, the most adequate topic antiseptic should be started as soon as possible. An appropriate and correct management of the wound care will allow to link the knowledge based on years of clinical practice with the new challenges and the need to visit patients remotely, when possible.

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Section: How To Treat Complex Woundsmentioning

confidence: 99%

“…FDA recently approved the use of dalbavancin, oritavancin, tedizolid and delafloxacin in the treatment of ABSSSIs. 48 , 49 …”

Section: Introductionmentioning

confidence: 99%

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What COVID‐19 taught us: New opportunities and pathways from telemedicine and novel antiseptics in wound healing

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Falcone

Avruscio

et al. 2021

International Wound Journal

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“…At the time of writing, many hospitals have scant availability of such resources. Therefore, diagnostic stewardship programs are being implemented for an evidence-based use of these new fast diagnostic tools that may facilitate the diagnostic process of common infectious syndromes [ 112 ]. Obviously, these tests can be considered in our algorithm as a tool for faster access to targeted therapy.…”

Section: Algorithm Constructionmentioning

confidence: 99%

Place in Therapy of the Newly Available Armamentarium for Multi-Drug-Resistant Gram-Negative Pathogens: Proposal of a Prescription Algorithm

et al. 2021

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The worldwide propagation of antimicrobial resistance represents one of the biggest threats to global health and development. Multi-drug-resistant organisms (MDROs), including carbapenem-resistant non-fermenting Gram-negatives and Enterobacterales, present a heterogeneous and mutating spread. Infections by MDRO are often associated with an unfavorable outcome, especially among critically ill populations. The polymyxins represented the backbone of antibiotic regimens for Gram-negative MDROs in recent decades, but their use presents multiple pitfalls. Luckily, new agents with potent activity against MDROs have become available in recent times and more are yet to come. Now, we have the duty to make the best use of these new therapeutic tools in order not to prematurely compromise their effectiveness and at the same time improve patients’ outcomes. We reviewed the current literature on ceftazidime/avibactam, meropenem/vaborbactam and cefiderocol, focusing on antimicrobial spectrum, on the prevalence and mechanisms of resistance development and on the main in vitro and clinical experiences available so far. Subsequently, we performed a step-by-step construction of a speculative algorithm for a reasoned prescription of these new antibiotics, contemplating both empirical and targeted use. Attention was specifically posed on patients with life-risk conditions and in settings with elevated prevalence of MDRO.

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“…The logical extension should suggest that 'diagnostic stewardship' is performing the right test, on the right patient, at the right time. Editorials and reviews have attempted to define the term [9,[15][16][17], and some have detailed the various stages where interventions may be applied in the pre-analytical, analytical and post-analytical phases [9]. However, publications, including systematic reviews [18], retrospective studies [19,20] and multi-centre validation of machine learning tools [21], have used the term without defining it.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic stewardship in infectious diseases: a scoping review

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Pickering,

Goolden

et al. 2024

Journal of Medical Microbiology

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Introduction. The term ‘diagnostic stewardship’ is relatively new, with a recent surge in its use within the literature. Despite its increasing popularity, a precise definition remains elusive. Various attempts have been made to define it, with some viewing it as an integral part of antimicrobial stewardship. The World Health Organization offers a broad definition, emphasizing the importance of timely, accurate diagnostics. However, inconsistencies in the use of this term still persist, necessitating further clarification. Gap Statement. There are currently inconsistencies in the definition of diagnostic stewardship used within the academic literature. Aim. This scoping review aims to categorize the use of diagnostic stewardship approaches and define this approach by identifying common characteristics and factors of its use within the literature. Methodology. This scoping review undertook a multi-database search from date of inception until October 2022. Any observational or experimental study where the authors define the intervention to be diagnostic stewardship from any clinical area was included. Screening of all papers was undertaken by a single reviewer with 10% verification by a second reviewer. Data extraction was undertaken by a single reviewer using a pre-piloted form. Given the wide variation in study design and intervention outcomes, a narrative synthesis approach was applied. Studies were clustered around common diagnostic stewardship interventions where appropriate. Results. After duplicate removal, a total of 1310 citations were identified, of which, after full-paper screening, 105 studies were included in this scoping review. The classification of an intervention as taking a diagnostic stewardship approach is a relatively recent development, with the first publication in this field dating back to 2017. The majority of research in this area has been conducted within the USA, with very few studies undertaken outside this region. Visual inspection of the citation map reveals that the current evidence base is interconnected, with frequent references to each other’s work. The interventions commonly adopt a restrictive approach, utilizing hard and soft stops within the pre-analytical phase to restrict access to testing. Upon closer examination of the outcomes, it becomes evident that there is a predominant focus on reducing the number of tests rather than enhancing the current test protocol. This is further reflected in the limited number of studies that report on test performance (including protocol improvements, specificity and sensitivity). Conclusion. Diagnostic stewardship seems to have deviated from its intended course, morphing into a rather rudimentary instrument wielded not to enhance but to constrict the scope of testing. Despite the World Health Organization’s advocacy for an ideology that promotes a more comprehensive approach to quality improvement, it may be more appropriate to consider alternative regional narratives when categorizing these types of quality improvement interventions.

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Diagnostic stewardship based on patient profiles: differential approaches in acute versus chronic infectious syndromes

Abstract: Venditti (2021): Diagnostic stewardship based on patient profiles: differential approaches in acute versus chronic infectious syndromes, Expert Review of Anti-infective Therapy,

Cited by 7 publications

References 103 publications

What COVID‐19 taught us: New opportunities and pathways from telemedicine and novel antiseptics in wound healing

What COVID‐19 taught us: New opportunities and pathways from telemedicine and novel antiseptics in wound healing

Place in Therapy of the Newly Available Armamentarium for Multi-Drug-Resistant Gram-Negative Pathogens: Proposal of a Prescription Algorithm

Diagnostic stewardship in infectious diseases: a scoping review

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