ISAC / APUA article

Diagnostic stewardship in infectious diseases: a continuum of antimicrobial stewardship in the fight against antimicrobial resistance. International Journal of Antimicrobial Agents. 2023.
Johnny Zakhour, Sara F Haddad, Anthony Kerbage, Wertheim Heiman, Pierre Tattevin, Andreas Voss, Serhat Ünal, Abdoul Salam Ouedraogo, Souha S Kanj on behalf of the International Society of Antimicrobial Chemotherapy (ISAC) and the Alliance for the Prudent Use of Antibiotics (APUA)

This excellent paper is written on behalf of ISAC and the Alliance for the Prudent Use of Antibiotics (APUA).

Abstract

Antimicrobial resistance (AMR) is an imminent threat to global health and has been exacerbated by the inappropriate use of diagnostics that lead to excessive prescription of antimicrobials. Diagnostic stewardship (DS) is an auxiliary to antimicrobial stewardship (AMS) and emphasizes on ordering the right tests for the right patient at the right time. It also promotes the judicious use of rapid and novel molecular diagnostic tools to allow for initiation of proper antibiotic therapy while avoiding excessive use of broad-spectrum antibiotics when not needed. Proper interpretation of test results is crucial to avoid overdiagnosis, and excessive healthcare costs. Although many rapid diagnostic tools have been developed with a high diagnostic yield, they are often limited by accessibility, cost, and lack of knowledge regarding their use. Careful consideration of clinical signs and symptoms with knowledge of the local epidemiology are cardinal for DS. This allows for appropriate interpretation of microbiological results. Multidisciplinary teams that involve well trained professionals should cooperate to promote DS. Challenges and barriers to the implementation of DS are mostly caused by scarcity of resources and trained personnel, and most importantly, lack of knowledge. The lack of resources is often due to absence of awareness of the impact that good medical microbiology diagnostic facilities and expertise can have on the proper use of antibiotics.

https://www.sciencedirect.com/science/article/pii/S092485792300095X