From guesswork to guidelines: advancing diagnostic stewardship in immunocompromised hosts

Area of Science:

• Medical Diagnostics
• Infectious Diseases
• Immunocompromised Hosts

Background:

• Diagnostic stewardship is crucial for optimizing medical testing and improving patient outcomes.
• Data on diagnostic stewardship specifically for immunocompromised patients remain limited.
• Immunocompromised patients present unique challenges due to altered immune responses and increased infection risk.

Purpose of the Study:

• To review recent advancements in diagnostic stewardship.
• To outline best practice principles for diagnostic stewardship in immunocompromised patients.
• To identify challenges and future research directions in this field.

Main Methods:

• Literature review of recent advances in diagnostic stewardship.
• Examination of key clinical scenarios in immunocompromised patients.
• Synthesis of expert opinion on challenges and future research.

Main Results:

• The review covers diagnostic stewardship for febrile neutropenia, CNS infections, invasive fungal infections, cytomegalovirus, and Clostridioides difficile infections.
• Key challenges include optimizing test use, interpreting diagnostics in immunosuppression, and proving cost-effectiveness.
• A multidisciplinary approach combining diagnostic and antimicrobial stewardship is recommended.

Conclusions:

• Effective diagnostic stewardship requires a collaborative, multidisciplinary approach.
• Further research, including prospective evaluations, is needed to assess the impact of diagnostic stewardship interventions in immunocompromised hosts.
• Optimizing diagnostic testing is essential for improving outcomes in complex immunocompromised patient populations.