Diagnostic Stewardship to Prevent Diagnostic Error

Morgan, Daniel J.; Malani, Preeti N.; Diekema, Daniel J.

doi:10.1001/jama.2023.1678

Cited by 18 publications

(21 citation statements)

References 9 publications

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“…Conceptually related to antibiotic stewardship, diagnostic stewardship is focused on improving the use of microbiology laboratory tests to ensure that patients receive correct, timely and pathogen-focused treatment [2] or rather the Right test , for the Right patient , prompting the Right action [3 ▪▪ ]. Appropriate use of diagnostic testing can improve antibiotic use, helping to reduce resistance and improving patient outcomes [1,3 ▪▪ ,4 ▪ ,5 ▪ ]. This review focuses on recently published diagnostic stewardship studies of common clinical infectious syndromes in adults and the impact on antibiotic prescribing and resistance…”

Section: Introductionmentioning

confidence: 99%

Diagnostic stewardship: what impacts antibiotics use?

Coffey

Morgan

Claeys

2023

Current Opinion in Infectious Diseases

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Purpose of review The aim of this study was to review recently published diagnostic stewardship studies of common clinical infectious syndromes and the impact on antibiotic prescribing. Recent findings Diagnostic stewardship can be implemented within healthcare systems and tailored to infectious syndromes, including urinary tract, gastrointestinal, respiratory and bloodstream infections. In urinary syndromes, diagnostic stewardship can decrease unnecessary urine culturing and associated antibiotic prescribing. Diagnostic stewardship of Clostridium difficile testing can decrease antibiotics and test ordering with a reduction in healthcare-associated C. difficile infections. Respiratory syndrome multiplex arrays can decrease time to results and increase detection of clinically relevant pathogens but may not decrease antibiotics use, or worse, could increase over-prescribing if diagnostic stewardship of ordering practices is not exercised. Lastly, blood culturing practices can be improved by clinical decision support to safely decrease collection and broad-spectrum antibiotic use. Summary Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship in patient care activities to leverage integration into systems-based interventions.

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Section: Introductionmentioning

confidence: 99%

Diagnostic stewardship: what impacts antibiotics use?

Coffey

Morgan

Claeys

2023

Current Opinion in Infectious Diseases

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“…The current randomized clinical trial 7 does add to the discussion about the value of diagnostic tests to inform treatment of common pediatric illnesses. 8 The authors found that antibiotics reduced acute bacterial sinusitis symptom duration for children who tested positive for common nasopharyngeal pathogens. 7 However, nasopharyngeal…”

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confidence: 99%

“…Broad respiratory pathogen panels have filled this clinical demand, but also demonstrate the limitations of diagnostic testing, especially because a positive test result does not distinguish colonization, infection, or even residual antigenic or genetic material. The current randomized clinical trial does add to the discussion about the value of diagnostic tests to inform treatment of common pediatric illnesses . The authors found that antibiotics reduced acute bacterial sinusitis symptom duration for children who tested positive for common nasopharyngeal pathogens .…”

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confidence: 99%

Acute Bacterial Sinusitis

Caballero,

Altillo,

Milstone

2023

JAMA

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Millions of cases of upper respiratory tract infections (URTIs) occur in the US each year and are more common among children than adults. Most URTIs are viral in origin and selflimited, but up to 50% of all patient encounters for viral URTI may result in an antibiotic prescription. 1 Approximately 7.5% of URTIs in children are complicated by acute bacterial sinusitis. 2 A clinical practice guideline from the American Academy of Pediatrics 3 recognizes acute bacterial sinusitis as a clinical diagnosis based on the duration and severity of symptoms for URTIs, with the treatment ranging from close observation to a 10-day course of antibiotics. The clinical practice guideline from the American Academy of Pediatrics has been revised only once during the past 2 decades, in part due to scant cumulative data from randomized clinical trials to inform further guidance.Clinical guidelines for diagnosis and treatment are an important foundation for antibiotic stewardship in ambulatory pediatrics. Antibiotic stewardship is an area of increasing importance, particularly in ambulatory pediatrics because viral URTIs are common. 1 Management of URTIs includes parental

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“…Reportable health care-associated infection (HAI) metrics that are at least partially based in laboratory reporting have contributed to the development of diagnostic stewardship. 5 Some HAI metrics, such as catheter-associated UTI or Clostridioides difficile infection, have led to a focus on improved testing. Diagnostic stewardship appears to decrease rates of these HAIs by 30% to 60%.…”

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confidence: 99%

“…Diagnostic stewardship appears to decrease rates of these HAIs by 30% to 60%. 5 It is notable that laboratorybased metrics are some of the few drivers to reduce overtesting and medical overuse. The study by Vaughn et al 4 focused on ASB, which was recently endorsed by the National Quality Forum as a metric of inappropriate diagnosis of UTI in hospitalized patients.…”

mentioning

confidence: 99%