Utility and Applicability of Rapid Diagnostic Testing in Antimicrobial Stewardship in the Asia-Pacific Region: A Delphi Consensus

Abstract

Rapid diagnostic tests (RDTs) facilitate fast and accurate identification of infectious disease microorganisms and are a valuable component of multimodal antimicrobial stewardship (AMS) programs, but are currently underutilized in Asia Pacific. An experienced group of infectious diseases clinicians, clinical microbiologists and a clinical pharmacist used a modified Delphi consensus approach to construct 10 statements aiming to optimize the utility and applicability of infection-related RDTs for AMS in the Asia Pacific region. They provide guidance on definition, types, optimal deployment, measuring effectiveness, and overcoming key challenges. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to indicate the strength of the recommendation and the quality of the underlying evidence. Given the diversity of Asia Pacific, the trajectory of RDT development will vary widely; the collection of local data should be prioritized to allow realization and optimization of the full benefits of RDT in AMS.

Rapid Diagnostic Test Value and Implementation in Antimicrobial Stewardship Across Low-to-Middle and High-Income Countries: A Mixed-Methods Review

“…To explore the value and impact of RDTs within an ASP, one must first consider the global definition of an RDT. The EWG agreed that a wide range of definitions exist for ‘rapid’, varying from 90 min up to 24 h. According to a Delphi Consensus in Asia–Pacific, RDTs should provide results within 4–6 h to determine treatment before administration of the second dose of an antimicrobial [ 18 ]. To accommodate a variety of settings, where this is not possible delivery of results within 24 h may be acceptable [ 2 ].…”

“…To achieve optimal antimicrobial use, RDTs must be used to facilitate decision-making at various stages of the clinical pathway, i.e. antimicrobial initiation, on-treatment, and de-escalation [ 18 ]. Use of RDTs as part of bundled interventions that support decision-making is key.…”

“…ASPs must document clinical and economic outcomes associated with each RDT and consequent impact on patient care [ 36 , 65 ]; the 5P approach enables a whole-healthcare economy lens through which to make these evaluations. Hospitals and long-term healthcare facilities must establish key performance indicators (KPIs) to measure RDT effectiveness [ 18 ]. “It is important to tailor [KPIs] to what you can accomplish [in your setting].…”

The Production of Antibiotics Must Be Reoriented: Repositioning Old Narrow-Spectrum Antibiotics, Developing New Microbiome-Sparing Antibiotics

“…At the hospital level, the development of rapid molecular techniques now allows for rapid de-escalation strategies or even immediate documented treatment, making it possible to spare broad-spectrum molecules [ 50 , 51 ]. Abbara and colleagues showed that an antibiotic stewardship program promoting a strategy of systematic de-escalation associated with restricted use of molecules with a high ecological impact made it possible to achieve a lasting drop in the resistance rate of Pseudomonas aeruginosa in an intensive care unit.…”

Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement

“…Selecting the appropriate test can be particularly difficult when the clinical presentation overlaps several etiologies. Rapid molecular diagnostics, generally defined as providing a result within 4–6 h, that test for a range of potential pathogens are becoming increasingly ubiquitous and offer much promise for improving outcomes [ 11 ]. These panels testing for multiple pathogens with a single test have improved diagnostic yield compared to the standard of care where one to many individual tests are ordered.…”