Recommendations for a microbiology Diagnostic Stewardship Program for antimicrobial resistance: Pre-analytical phase

Area of Science:

• Clinical Microbiology
• Infectious Diseases
• Healthcare Management

Background:

• Diagnostic Stewardship Programs (DSPs) are crucial for optimizing diagnostic test utilization.
• Antimicrobial resistance (AMR) necessitates improved diagnostic strategies.
• Integration of DSPs with Infection Prevention and Control (IPC) and Antimicrobial Stewardship Programs (ASPs) is vital.

Purpose of the Study:

• To focus on the pre-analytical phase of DSPs, specifically test ordering.
• To provide algorithms for ordering blood, urine, and respiratory cultures.
• To offer recommendations for resource-limited settings.

Main Methods:

• Development of algorithms for rational test ordering based on pretest probability.
• Standardization of ordering criteria for blood cultures, emphasizing high-risk populations.
• Guidelines for urine culture ordering based on symptomatic presentation.
• Consideration of patient condition and resources for respiratory specimen testing.

Main Results:

• Pretest probability is a key concept for guiding rational test ordering and reducing overutilization.
• Standardized criteria for blood cultures improve yield and resource utilization.
• Avoiding urine cultures for asymptomatic bacteriuria prevents unnecessary laboratory workload.
• Molecular techniques for respiratory specimens require integration with ASPs for effective antimicrobial use.

Conclusions:

• Rational test ordering in the pre-analytical phase is essential for effective DSPs.
• Algorithms and standardized criteria enhance diagnostic accuracy and resource optimization.
• Strategic integration of diagnostic and antimicrobial stewardship is key to combating AMR.