Diagnostic stewardship in infectious diseases: a continuum of antimicrobial stewardship in the fight against antimicrobial resistance

Zakhour, Johnny; Haddad, Samuel; Kerbage, Anthony; Heiman, Wertheim; Tattevin, Pierre; Voß, Andreas; Ünal, Serhat; Ouédraogo, Abdoul Salam; Kanj, Souha S.

doi:10.1016/j.ijantimicag.2023.106816

Cited by 26 publications

(4 citation statements)

References 113 publications

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“…Likewise, the rapid detection of multi-resistant or highly transmissible microorganisms enables the implementation of control measures to restrict their transmission, a fact that has become especially clear with the emergence of SARS-CoV-2. The utility of RDTs in reducing turnaround time has been highlighted in several studies, but their implementation without the support of an ASP has yielded modest advantages in terms of optimizing antimicrobial therapy and impacting patient outcomes [43][44][45][46][47][48][49]. The use of RDTs requires the multidisciplinary involvement of microbiologists, physicians, and pharmacists to ensure that the indication is appropriate and that the result information is properly interpreted by the responsible clinician to guarantee its usefulness in optimal patient management [43,44].…”

Section: Rapid Diagnostic Testsmentioning

confidence: 99%

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department

Ruiz-Ramos,

Escolà-Vergé,

Monje-López

et al. 2023

Antibiotics

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Over the last decades, we have witnessed a constant increase in infections caused by multi-drug-resistant strains in emergency departments. Despite the demonstrated effectiveness of antimicrobial stewardship programs in antibiotic consumption and minimizing multi-drug-resistant bacterium development, the characteristics of emergency departments pose a challenge to their implementation. The inclusion of rapid diagnostic tests, tracking microbiological results upon discharge, conducting audits with feedback, and implementing multimodal educational interventions have proven to be effective tools for optimizing antibiotic use in these units. Nevertheless, future multicenter studies are essential to determine the best way to proceed and measure outcomes in this scenario.

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Section: Rapid Diagnostic Testsmentioning

confidence: 99%

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department

Ruiz-Ramos,

Escolà-Vergé,

Monje-López

et al. 2023

Antibiotics

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“…Although efforts are being made to implement antimicrobial stewardship (AMS) measures to curb overuse and discourage unwarranted antibiotic prescribing, the effectiveness of AMS programmes is hampered by the lack of rapid and reliable microbiological diagnostics. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

“…Expediting the time-to-result for urine diagnostics can significantly assist physicians in making informed decisions regarding antibiotic prescriptions. 3 Point-of-care diagnostic tests (POCTs), specifically using a lateral flow assay (LFA) to identify CTX-M beta-lactamases, a predominant mechanism underlying the ESBL phenotype in E. coli , directly from urine specimens, have been proposed for this purpose. 10–12 However, this approach may involve enriching or pre-incubating 10 mL urine samples, demanding sophisticated instrumentation and workflow, including more hands-on time to process the samples, thus hampering the POCT approach.…”

Section: Introductionmentioning

confidence: 99%

A proof-of-principle study for the point-of-care detection of ESBL (CTX-M) by NG-Test® CTX-M MULTI lateral flow assay in urine samples using a simplified method for use in a resource-limited setting

Nurjadi,

Chalin,

Hauswaldt

et al. 2024

JAC-Antimicrobial Resistance

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Background The rise of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in low- and middle-income countries limits treatment options, leading to the frequent use of broad-spectrum antibiotics. Reducing time-to-result for a urinary infection can facilitate correct antibiotic treatment and support antimicrobial and diagnostic stewardship measures. This study compared two simplified enrichment methods for detecting CTX-M directly from urine specimens. Methods Two enrichment methods, namely centrifugation of 2 mL urine and filtration of 1 mL urine using the DirecTool adaptor, were compared using 20 culture-positive urine samples (20 suspected ESBL-E and 20 non-ESBL-E). CTX-M production was detected using a lateral flow assay (LFA), NG-Test® CTX-MMULTI. The presence of blaCTX-M genes was confirmed by whole-genome sequencing (WGS). Results The results of both enrichment methods were identical, with a sensitivity of 87.5% and a specificity of 100%. In 19/20 (95%) of the urine samples, the results of the CTX-M LFA were identical with the phenotypic confirmation and WGS. Both methods could detect ESBL-E bacteriuria with ≥104 cfu/mL. All ESBL-E-negative samples were identified accurately. Both enrichment methods yielded negative results in one ESBL-E-positive (CTX-M-15) sample despite phenotypic and genotypic confirmation of ESBL production. High leukocyte count (>500 cells/µL), the presence of boric acid or polymicrobial samples did not appear to impact the performance of both enrichment methods. Conclusions Our study underscores the feasibility of directly detecting CTX-M in urine. Simplified enrichment methods, particularly with a filtration kit, enhance the assay’s practicality, rendering it suitable for use in primary care, emergency departments or remote laboratories without sophisticated equipment.

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“…The principles of DS are of utmost importance when considering the harrowing trends in healthcare-associated infections (HAIs) and the overall inappropriate or excessive use of diagnostic testing [ 6 , 7 , 8 ]. It mandates meticulous scrutiny of clinical indications before ordering diagnostic tests, considers individual patient characteristics, understands the diagnostic accuracy within different clinical settings, and promotes appropriate and timely diagnostic testing [ 9 ]. However, despite the clear potential of DS, ambiguities in comprehensive understanding of the topic and its application persist [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding and Implementing Diagnostic Stewardship: A Guide for Resident Physicians in the Era of Antimicrobial Resistance

Schinas,

Dimopoulos,

Akinosoglou

2023

Microorganisms

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Antimicrobial resistance (AMR) poses a significant global health challenge, exacerbated by the COVID-19 pandemic. Antimicrobial stewardship programs (ASPs) are crucial in managing this crisis, with diagnostic stewardship (DS) emerging as a key component. DS refers to the appropriate use of diagnostic tests to optimize patient outcomes, improve antimicrobial use, and combat multi-drug-resistant (MDR) organisms. Despite its potential, understanding and application of DS remain ambiguous in multiple respects, which, however, do not directly implicate the implementation of such initiatives. DS is particularly important for resident physicians who are often at the forefront of patient care and can significantly influence future AMR strategies. This review provides a comprehensive overview of DS, discussing its importance, potential challenges, and future directions. It emphasizes the need for resident physicians to understand DS principles and integrate them into their clinical practice from the beginning of their careers. The review also highlights the role of various stakeholders in implementing DS and the importance of continuous education and training. Ultimately, DS is not just a clinical tool but a philosophy of care, essential for a more responsive, humane, and effective healthcare system.

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Diagnostic stewardship in infectious diseases: a continuum of antimicrobial stewardship in the fight against antimicrobial resistance

Cited by 26 publications

References 113 publications

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department

A proof-of-principle study for the point-of-care detection of ESBL (CTX-M) by NG-Test® CTX-M MULTI lateral flow assay in urine samples using a simplified method for use in a resource-limited setting

Understanding and Implementing Diagnostic Stewardship: A Guide for Resident Physicians in the Era of Antimicrobial Resistance

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