Accelerating the Development and Uptake of Rapid Diagnostics to Address Antibiotic Resistance Proceedings of a Workshop (2023) / Chapter Skim
Currently Skimming:
6 Diagnostic Stewardship
6 Diagnostic Stewardship
Pages 63-76
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 63... ...
• The impact of a rapid diagnostic use will vary depending on local resistance rates, antibiotic prescribing practices, patient populations, the availability of stewardship programs, and base line laboratory practices. (Banerjee)
|
From page 64... ...
The next stage of testing is the analytical phase, said Burnham; at this point, diagnostic stewardship includes decisions about methodology, batch vs. on demand processing, and where a test will be processed (central laboratory vs.
|
From page 65... ...
There is a need for more research on the impact of rapid diagnostics on multiple outcomes including clinical outcomes, workflow, and decisionmaking. In addition, said Burnham, there is a need for formal mechanisms for ongoing evaluation of the performance of rapid diagnostics; this will require strong partnerships between microbiology and antimicrobial stewardship programs.
|
From page 66... ...
The challenge, said Banerjee, is that conventional bacterial blood cultures and antibiotic susceptibility testing methods typically take days to yield actionable information. Rapid diagnostics can shorten this time, but the clinical impact must be demonstrated.
|
From page 67... ...
Y/N Y Y (ASP only) Y - Timbrook, 2017 SOURCE: Presented by Ritu Banerjee, October 14, 2022.
|
From page 68... ...
savings Study Same day Microscan All 573 N Y Y N Y Doern, 1994, US Multiplex PCR All 250 N Y N N - Beuving, 2015, Netherlands BCID All 617 Y Y N N N Banerjee, 2015, US MALDI-TOF All 425 Y Y N N - Ostoff, 2017, Switzerland Accelerate Pheno GN 448 Y Y N N N Banerjee, 2020, US MALDI-TOF All 3127 Y N N N N MacGowan, 2020, England and Whales QMAC-dRAST All 89 Y Y N N N Kim, 2021, Korea Accelerate Pheno GN 205 Y Y N -2 - Christensen, 2022, US NOTE: ASP = antibiotic stewardship program oversight; GN = gram-negative; LOS = length of stay; Org = organism; SS = subjects selected; TOT = time to optimal therapy SOURCE: Presented by Ritu Banerjee, October 14, 2022.
|
From page 69... ...
difficile = Clostridioides difficile; cx = culture; ICU = intensive care unit; MDRO = multidrug resistant organisms; rxn = reaction awith same organism bVRE, MRSA, ESBLs, Gram-negatives resistant to > 3 drug classes cMean (median) among inpatients with available data (n = 544)
|
From page 70... ...
First, rapid blood culture diagnostics, when implemented in collaboration with antibiotic stewardship teams, can improve treatment optimization for patients with bloodstream infections. Optimized treatment means faster antibiotic modifications, more judicious antibiotic use, and more timely antibiotic administration.
|
From page 71... ...
They found that the guidelines on antimicrobial steward ship programs recommend the use of rapid diagnostics in combination with traditional methods and that most guidelines for individual practice areas recommend traditional methods. Sporadic recommendations for point-ofcare or rapid testing were not specific about how and when to use these diagnostics.
|
From page 72... ...
72 FIGURE 6-3 A multinational survey on antimicrobial stewardship program practice and rapid diagnostic utilization NOTE: AB = antibiotic; AMS = antimicrobial stewardship; AMR = antimicrobial resistance; LOS = length of stay SOURCE: Presented by Diane Flayhart, October 14, 2022; Survey Study Design, BD, Wellcome, Pfizer.
|
From page 73... ...
There are complexities and challenges with accomplishing this, but it would allow antibiotic stewardship teams to measure how diagnostics are impacting antibiotic use. Antibiotic use increases during cold and flu season, which could offer an opportunity for stewardship programs to track and evaluate appropriate antibiotic use and the role of diagnostics (Yu et al., 2022)
|
From page 74... ...
Role of guidelines Burnham pointed out that guidelines are typically developed by volunteers who have many other duties, so it would be useful to have financial resources for professional help with tasks such as literature reviews to help speed up the process, particularly given that this field evolves quickly over time. Additionally, guideline development should be useful for the end users, so it is important to incorporate the input of people who might rely on diagnostic tests, including laboratory directors, medical specialists and infectious disease experts.
|
From page 75... ...
There is value in reducing societal levels of AMR, and this should be reflected in accreditation or joint commission surveys. For example, if a survey asks hospitals if they monitor certain metrics related to AMR, hospital leadership is likely to adopt new practices to maintain accreditation and ratings.
|
From page 76... ...
76 DEVELOPMENT AND UPTAKE OF RAPID DIAGNOSTICS be demonstrated that a diagnostic provides actionable results within a certain timeframe and has downstream clinical benefit, then those benefits should be applied to equivalent tests as they move through clinical outcome studies.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.