IDSE Review
The Importance of Rapid Diagnostic Testing and Stewardship for Infectious Disease Management KAREN FONG, PHARMD, BCIDP
R
apid diagnostic tests (RDTs) have fundamentally transformed infectious disease management by providing rapid and robust microbiological diagnoses. In the modern-day expansion of molecular technology, direct-specimen rapid amplification and detection platforms and next-generation sequencing (NGS) are techniques that provide laboratory diagnoses at a speed, sensitivity, and breadth never before possible with conventional microbiology.1 Newer technologies have expanded rapidly to detect genotypic markers of resistance, but rapid phenotypic antimicrobial susceptibility testing has been available only recently. Thus, these commercial advances add data to the clinical presentation and assist empiric antimicrobial selection by enabling the prediction of susceptibility patterns based on local antibiograms, but are not yet a replacement for cultures. Moreover, there may be drawbacks associated with RDTs, including cost and overuse, highlighting the potential beneficial role of stewardship in making clinical decisions.1 The general advantages and disadvantages of RDTs, specific to bloodstream infections (BSIs), are outlined by Briggs et al in Table 1.2
Due to the complexity of intervention with RDTs, RDT development and implementation must be coupled with education to facilitate informed decision making about implementation.2 Before implementation, an assessment of the clinical utility of these tests should be conducted, considering patient population and local epidemiology, along with antimicrobial stewardship programs (ASPs)
to justify the acquisition of new equipment testing methodologies.3 Along with rapid turnaround time for pathogen identification and accurate interpretation of susceptibility results, great pragmatism is required to ensure results are actionable and promptly addressed to improve clinical outcomes and reduce unnecessary antimicrobial use.3 ASPs may facilitate the correct
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