IDSE Review
Implementing Rapid Diagnostic Tests to Augment Antimicrobial Stewardship Programs: The Time Is Now BY SARAH M. WIECZORKIEWICZ, PHARMD, FIDSA, BCPS, BCIDP
F
or hospitalized, critically ill patients with sepsis, accurate and timely administration of antimicrobial agents is essential to prevent mortality.1,2 Rapid diagnostic tests (RDTs) have revolutionized the treatment of these patients and become one of the most powerful tools for antimicrobial stewardship programs (ASPs). Although routinely used laboratory methods, such as Gram stains, can provide helpful guidance in some clinical circumstances—such as stopping gram-positive coverage when a gram-negative organism is identified for a generally monomicrobial infection, de-escalating antipseudomonal coverage if ruled out, and so forth—they do not predict antimicrobial susceptibility patterns. In addition, routine laboratory methods often result in prolonged use of unnecessarily broad-spectrum antimicrobials or, even more concerning, ineffective therapy.
RDTs provide actionable details, even those without rapid susceptibility results, such as the ability to predict resistance patterns. When combined with the use of local antibiograms, knowledge of intrinsic resistance, and genotypic resistance marker detection, RDTs allow a more rapid, targeted approach to antimicrobial therapy. The impact of RDTs can be largely attributed to reduced duration of empiric antimicrobial therapy. Prolonged broad-spectrum empiric therapy can lead to an increased burden of Clostridioides difficile infection, antimicrobial resistance, and adverse events, such as acute kidney injury. On the contrary, erroneous empiric antimicrobial coverage can delay effective therapy to detrimental effects and lead to dramatic increases in mortality among critically ill patients.1-8 A recent study found delays in antimicrobial therapy in patients with carbapenem-resistant and -susceptible Enterobacteriaceae infections are more important for mortality than multidrug resistance (MDR).7
INFECTIOUS DISEASE SPECIAL EDITION • SPRING 2022
45
