Being a great steward of antimicrobials and diagnostic testing is fundamental when it comes to improving the use of microbiologic data to ensure optimal use of antimicrobials. Diagnostic stewardship aims to order the right test, for the right patient, at the right time, with the correct interpretation. Bridging this aim to antimicrobial stewardship, these efforts promote optimized treatment decisions and improved patient outcomes.
By leveraging stewardship and strong relationships with clinical microbiology laboratories, clinicians, pharmacists, and other healthcare professionals, the opportunity is great for AMS programs to affect positive changes throughout the diagnostic process and clinical decision-making. In fact, the CDC and Prevention Core Elements for AMS Programs designates diagnostic stewardship as a core part of successful AMS programs.
Whereas the aim of diagnostic stewardship is to perform the right test, at the right time, for the right patient, the aim of AMS is to establish the right diagnosis, treat with the right drug, at the right dose and duration. Prescribing the right therapy hinges on the right diagnosis being made, thus highlighting the pivotal role the clinical microbiology laboratory plays in any AMS program. It is important to realize that the laboratory’s role in contributing to the establishment of the right diagnosis extends far beyond the analytical phase (when a test is performed)1.
In the pre-analytic phase, the laboratory has the opportunity to put interventions in place that guide clinicians to appropriately order specific tests and submit appropriate sample types. These pre-analytic considerations are critical factors in the results from testing positively impacting patient care. Testing that is inappropriately ordered or has inappropriate samples submitted has the potential to result in diagnostic error. In the post-analytic phase, the laboratory contributes by contextualizing results and providing interpretive comments to support the appropriate interpretation of the result being provided.
Another notable contribution the laboratory makes is the maintenance of the test menu. Thousands of tests are available each with different performance characteristics, intended uses, and potential for informing patient care. It is the responsibility of the laboratory, in collaboration with other care teams, to maintain a test menu that is clinically relevant. Part of this effort is evaluating and characterizing the performance of new diagnostic tests and platforms, particularly rapid diagnostics that have the potential to make significant contributions to AMS by informing the diagnosis earlier in the patient journey.
There are many clinical practice areas that are priorities of AMS programs described in the literature that the clinical laboratory is well positioned to provide value to including sepsis, Clostridiodes difficle infection, and urinary tract infection. There are many more opportunities that lie ahead that will be identified and addressed through stronger relationships developed between the laboratory service and other care teams. The notion of stewardship as a complete practice and methodology requires, and at this point demands, collaboration between multidisciplinary groups of professionals.
Antimicrobial resistance (AMR) is a global threat to society, with deaths attributed to resistant infections projected to exceed 10 million per year by 2050. That projection alone communicates an immediate need for a unified effort across multiple disciplines. With the contributions of microbiology laboratory expertise and leveraging the vast amount of data produced by laboratory testing, a more informed collection of data and practices can take place to inform impactful stewardship activities, which is vital and necessary to combat this threat.
The COVID-19 pandemic dramatically displayed that teamwork across disciplines is imperative to the successful diagnosis and management of infectious diseases. A unique and effective forum for this teamwork is often displayed through rounding, providing collaborative discussion between experts to share their clinical insights for a positive impact on patient care. Stewardship interventions should aim to build this climate of trust that fosters relationships, education, and communication.
Forming that united front creates a continuum of AMS efforts through reliance on interdisciplinary perspectives and empirical data that informs optimized treatment decisions, supports judicious use of diagnostic tools, and identifies areas of unmet need that can inform the future direction of diagnostics development.
The combining of clinical microbiology laboratory perspectives and data with AMS interventions and programs provides the most optimal strategy for individual patients, institutions, and on a global scale. These efforts are critical if we are to combat the immediate threat antimicrobial resistance poses to patients and mitigate the dire projections of what this threat could become.
This guest editorial article was written by Kyle Hueth, Senior Manager in Global Medical Affairs at bioMérieux.
Kyle Hueth (M.S. in Laboratory Medicine and Biomedical Science [University of Utah] and board-certified Medical Laboratory Scientist and Specialist in Chemistry [ASCP]) is a Senior Manager in Global Medical Affairs at bioMérieux focused on the development of molecular syndromic assays. He has worked in the diagnostic field for more than 13 years, having spent nine years in the clinical setting before joining bioMérieux in 2018. In his clinical experience, he spent several years focused on diagnostic stewardship and worked with many health systems across the US to implement stewardship programs. Hueth has appreciated the opportunity to bring his clinical and diagnostic stewardship perspectives to the industry side of healthcare to support the development of diagnostics that improve patient outcomes.