IDSE Review
Rapid Diagnostic Testing and Biomarkers Implementation: The Starring Role of Antimicrobial Stewardship BY KAREN FONG, PHARMD, BCIDP
I
n the clinical microbiology laboratory, there have been truly exciting advances in microbiological diagnoses using rapid diagnostic tests (RDTs). The management of bacterial, viral, and fungal diseases has been fundamentally transformed by providing early clinical decision making through technological growth with the prospect of significantly affecting clinical outcomes, antimicrobial use, and cost savings.1-3 Although there are still shortcomings with antimicrobial susceptibility testing for bacterial and fungal cultures, RDTs provide valuable information to the clinical presentation, facilitating selection of empiric antimicrobial coverage by the prediction of susceptibility patterns based on local antibiograms.
In the early stages of sepsis, every hour of delay in commencing effective antimicrobial therapy increases the risk for death.4 The distinction between viral and bacterial infection, determination of specific bacterial etiology, and antimicrobial susceptibility testing must be available to quickly achieve maximum clinical benefit. In a proposed series by Inglis and Ekelund, 3 linked decision-making milestones with specific goals may resolve a trade-off between diagnostic confidence and therapeutic efficacy (Figure).5 The integration of RDTs into the initial investigation for sepsis and clinical laboratory workflow may expedite optimal disease management. RDT results must be actionable and promptly addressed with appropriate clinical interpretation and corresponding antimicrobial therapy adjustment. The role of antimicrobial stewardship programs (ASPs) may be exploited to correctly interpret and rapidly communicate results, directing clinicians to appropriate antimicrobial therapy.6 ASPs have continuously demonstrated their value through the improvement of clinical outcomes and reduction of adverse events by optimizing antimicrobial use.7,8 Inpatient ASPs have concomitantly improved the rates of infection
INFECTIOUS DISEASE SPECIAL EDITION • SUMMER 2021
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