Leveraging diagnostic stewardship within antimicrobial stewardship programmes

Abstract

Novel diagnostic stewardship in infectious disease consists of interventions that modify ordering, processing, and reporting of diagnostic tests to provide the right test for the right patient, prompting the right action. The interventions work upstream and synergistically with traditional antimicrobial stewardship efforts. As diagnostic stewardship continues to gain public attention, it is critical that antimicrobial stewardship programmes not only learn how to effectively leverage diagnostic testing to improve antimicrobial use but also ensure that they are stakeholders and leaders in developing new diagnostic stewardship interventions within their institutions. This review will discuss the need for diagnostic and antimicrobial stewardship, the interplay of diagnostic and antimicrobial stewardship, evidence of benefit to antimicrobial stewardship programmes, and considerations for successfully engaging in diagnostic stewardship interventions. This article is part of the Antibiotic stewardship Special Issue: https://www.drugsincontext.com/special_issues/antimicrobial-stewardship-a-focus-on-the-need-for-moderation

The importance of pharmacist engagement in diagnostic stewardship

“… 11 With rates of unnecessary antimicrobial treatment exceeding 70% in conditions such as asymptomatic bacteriuria, the need for improving diagnosis and tempering inappropriate antibiotic use through diagnostic stewardship is imperative. 12 …”

A decade of clinical microbiology: top 10 advances in 10 years: what every infection preventionist and antimicrobial steward should know

“…The focus of preanalytic innovations over the past decade has shifted to behavioral economics using automated system-based CDST to nudge clinicians earlier in clinical workup for better utilization of diagnostic tests. 1 , 2 Antimicrobial stewardship programs combined with information technology staff have played a crucial role in the design and implementation of CDST. Some examples of these novel interventions include: Best-practice alerts (BPAs) to stop unnecessary diagnostic testing in patients without symptoms of infection.…”

Diagnostic Stewardship

“…Klassisches Beispiel sind "routinemäßige" Urinkulturen vor nicht-urologischen chirurgischen Eingriffen, die dann nicht selten in die Behandlung einer asymptomatischen Bakteriurie münden (▶ Abb. 2, nach [3]).…”

“…B. der Clostridioides-difficile-Toxinnachweis noch über längere Zeit persistieren kann, ohne dass eine relevante Erkrankung vorliegt (▶ Abb. 3, nach[3]). Schulz-Stübner S. Diagnostic Stewardship ... Anästhesiol Intensivmed Notfallmed Schmerzther 2023; 58: 540-550 | © 2023.…”

“…die PCR-Diagnostik je nach verwendeten Geräten mitunter unterschiedliche Abstrichtupfer verwendet werden, um ein optimales Ergebnis zu erzielen. Während der Nasen-Rachen-Abstrich für die Diagnostik viraler Atemwegserkrankungen oder das MRSA-Screening eine entscheidende Rolle spielt, ist der oberflächliche Abstrich von chronischen Wunden für die klinische Diagnostik jenseits des Ausschlusses einer MRSA-Besiedlung ungeeignet, ebenso wie Abstriche von Katheteraustrittsstellen und Drainagen.Ebenfalls auf dieser Ebene werden die mehrschrittigen Algorithmen bei der Clostridioides-difficile-Diagnostik oder das Conditional Urine Reflex Testing eingeordnet, für die es im Rahmen von Diagnostic Stewardship die meiste Evidenz gibt[3]. Beim Conditional Urine Reflex Testing wird die Kultur nicht angelegt, wenn bestimmte Ausschlussoder Stoppkriterien erfüllt sind.…”