Abstract and Introduction
Abstract
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.
Introduction
Diagnostic stewardship refers to the process of modifying ordering, performing or reporting diagnostic test results to improve the accuracy of clinical diagnosis, treatment and intervention.[1] 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.[1,3–5] This review focuses on recently published diagnostic stewardship studies of common clinical infectious syndromes in adults and the impact on antibiotic prescribing and resistance.
Curr Opin Infect Dis. 2023;36(4):270-275. © 2023 Lippincott Williams & Wilkins
