The Present and Future State of Antimicrobial Stewardship and Rapid Diagnostic Testing: Can One Ideally Succeed Without the Other?

Abstract

Purpose of review The growth and development of rapid diagnostic technologies (RDTs) in infectious diseases (ID) have grown significantly over the past several years. The aim of these platforms is to identify causative pathogens more quickly and target antimicrobial therapy earlier, ultimately improving patient outcomes. Use of RDT specifically from blood specimens to optimize antimicrobial therapy and improve patient outcomes is a recommendation by the most recent antimicrobial stewardship (AMS) guidelines. In this review, we aim to highlight currently available FDA-approved RDTs for clinicians, data supporting the role of blood culture RDT platforms in AMS and their integration into clinical practice with and without AMS support to improve patient outcomes, as well as potential future opportunities for current and pending platforms. Recent findings New RDT platforms continue to enter the market, most recently with GenMark's ePlex Gram-positive and fungal panels. The Accelerate Pheno™ technology is unique in its ability to provide identification and phenotypic susceptibility results for pathogens included in its platform within 7 h. We anticipate more RDTs will continue to enter the market in the coming years. Across published literature, it has been shown the most significant impact in optimization of antimicrobial therapy occurs with integration of RDT with AMS intervention. Additionally, a recent meta-analysis showed a decreased mortality risk with use of RDT with AMS programs. Despite the perceived benefit of RDT, cost can be a major obstacle for institutions and data on the fiscal impact and associated return on investment are still needed. Summary Rapid diagnostics in ID and AMS programs continue to grow. Data has shown the benefit of RDTs with AMS intervention, especially in the realm of positive blood cultures. Expansion of RDTs in all culture sites continues to be a need for patients as well as further literature to justify the high costs for these technologies.

An Overview of Healthcare Associated Infections and Their Detection Methods Caused by Pathogen Bacteria in Romania and Europe

“…An important strategy to reduce AMR is the use of rapid diagnosis for bacterial infections. Studies have shown that the use of rapid diagnosis methods for bacterial infections as part of ASP can improve the time to optimal antibiotic therapy, decreasing the rate of recurrent infection, mortality, hospital duration and hospital costs [ 115 ].…”

Optimizing rapid diagnostics and diagnostic stewardship in Gram‐negative bacteremia

“…These systems vary in number of pathogens identified and resistance mechanisms detected and are meant to be used in conjunction with traditional antimicrobial susceptibility testing methods. Table 1 provides a summary of the RDTs for detecting Gram‐negative bacteria currently available in the United States 16‐26 . The technologies primarily utilize single and multiplex polymerase chain reaction (PCR, mPCR) to rapidly identify bacteria and/or resistance mechanisms by detecting specific DNA and/or protein sequences.…”

“…Each system has strengths and weaknesses (Table 2). 23,24,26–28 Local epidemiology, resistance patterns, and target patient population can help clinicians determine which system(s) to employ.…”

Análisis del impacto de los test de diagnóstico virológico en el consumo de antibióticos en pacientes pediátricos ingresados por neumonía adquirida en la comunidad

“…El desarrollo de nuevas técnicas de diagnóstico microbiológico que permiten la identificación del microorganismo causal en menor tiempo está permitiendo optimizar el consumo de antimicrobianos. Dentro de estas pruebas destacan las técnicas de diagnóstico virológico rápido en muestras respiratorias 3 .…”