Ushering in Diagnostic Stewardship: a Step Towards Antibiotic Stewardship
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Antimicrobial Stewardship (M Stevens, Section Editor)
Ushering in Diagnostic Stewardship: a Step Towards Antibiotic Stewardship Alessia Savoldi, MD1,* Elisa Gentilotti, MD1 Pasquale De Nardo, MD1 Elisa Razzaboni, MD1 Chiara Bovo, MD2 Elena Carrara, MD1 Address *,1 Division of Infectious Diseases, Department of Diagnostic and Public Health, G. B Rossi University Hospital, University of Verona, P.le L.A Scuro 10, 37100, Verona, Italy Email: [email protected] 2 Medical Direction, University Hospital of Verona, P.le L.A Scuro 10, 37100, Verona, Italy
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Antimicrobial Stewardship Keywords Antibiotic stewardship I Diagnostic stewardship I Rapid diagnostics techniques I Microbiology laboratory
Abstract Purpose of review In recent years, there have been significant developments in rapid diagnostic techniques (RDTs) in microbiology for the diagnosis of infectious diseases. By providing a more rapid diagnosis, RDTs have the potential to affect diagnostic algorithms and therapeutic decisions. In addition to “antibiotic stewardship,” the term “diagnostic stewardship” has recently been coined in clinical practice and denotes the promotion of a rational implementation of diagnostic tests with a view to improving the quality of care and safely reducing cost. This review explores the advancement of diagnostic and antibiotic stewardship in the implementation of RDTs and describes the most relevant related clinical applications in Clostridioides difficile infections (CDIs), bloodstream infections (BSIs), and respiratory infections. Recent findings An innovative evidence-based RDT diagnostic algorithm that varies according to the presence of pre-agreed institutional criteria significantly increases testing accuracy for differentiating CDIs from carriage status. Evidence on BSIs reveals that pairing RDTs and antibiotic stewardship eases timely and appropriate utilization of RDTs results that may improve the clinical outcomes by optimizing antibiotic use. Data on
Antimicrobial Stewardship (M Stevens, Section Editor)
clinical implications of RDTs targeting antibiotic-resistant Gram-negative and respiratory infections are scarce and inconclusive. Summary Intertwining the role of diagnostic and antibiotic stewardship is crucial to optimizing RDTs utilization, by ensuring that RDTs are rationally selected and implemented, and results correctly interpreted and applied to clinical practice. Further research is needed to explore the clinical implications of RDT implementation.
Introduction Antibiotic stewardship programs (ASPs) aim to optimize antibiotic prescription that results in the best clinical outcomes for the treatment or prevention of infections, with minimal toxicity to the patients and minimal impact on subsequent resistance [1, 2]. ASPs have been increasingly implemented in various healthcare and community settings and demonstrated to be effective in reducing antibiotic consumption, the length of hospi
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