Is diagnostic stewardship possible in solid organ transplantation?

Area of Science:

• Infectious Diseases
• Transplant Medicine
• Clinical Diagnostics

Background:

• Solid organ transplant (SOT) recipients are vulnerable to over-testing and overtreatment.
• Diagnostic stewardship offers a potential solution to mitigate these risks in SOT patients.

Purpose of the Study:

• To review potential targets for diagnostic stewardship in SOT recipients.
• To explore novel areas for diagnostic stewardship in this population.

Main Methods:

• Review of diagnostic stewardship targets in SOT.
• Analysis of interventions for Clostridioides difficile testing.
• Evaluation of urine culture utility in renal transplant recipients.
• Identification of novel diagnostic stewardship areas.

Main Results:

• Bundled interventions significantly decreased Clostridioides difficile testing and diagnosis without adverse effects.
• Screening urine cultures did not improve outcomes in stable renal transplant recipients post-transplant.
• Noninvasive fungal diagnostics and cytomegalovirus testing strategies are novel areas for future study.

Conclusions:

• Diagnostic stewardship can enhance diagnosis and reduce unnecessary antimicrobial use in SOT.
• While direct research in SOT is limited, significant potential benefits exist.
• Implementing diagnostic stewardship in SOT requires a multidisciplinary approach to ensure appropriate test utilization and patient benefit.