Diagnostic stewardship: what impacts antibiotics use?

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Health Services Research

Background:

• Diagnostic stewardship is crucial for optimizing antibiotic use in common infectious syndromes.
• Reviewing recent studies highlights the impact of diagnostic stewardship on antibiotic prescribing patterns.

Approach:

• Systematic review of recently published diagnostic stewardship studies.
• Analysis of impact on antibiotic prescribing for urinary tract, gastrointestinal, respiratory, and bloodstream infections.

Key Points:

• Diagnostic stewardship reduces unnecessary urine culturing and antibiotic use in urinary syndromes.
• It decreases Clostridium difficile testing and associated antibiotic use, lowering healthcare-associated infections.
• Respiratory multiplex arrays may not decrease antibiotic use without careful stewardship of ordering practices.
• Clinical decision support for blood culturing can reduce collection and broad-spectrum antibiotic use.

Conclusions:

• Diagnostic stewardship complements antibiotic stewardship by decreasing unnecessary antibiotic use.
• Further research is needed to fully quantify its impact on antibiotic use and resistance.
• Institutionalizing diagnostic stewardship into patient care is essential for systems-based interventions.