Antimicrobial Stewardship and Rapid Diagnostic Testing in Acute Care
Implementation of effective antimicrobial stewardship programs (ASP) typically requires a multipronged approach. The Infectious Diseases Society of America (IDSA) and Society of Healthcare Epidemiology of America Guidelines on ASP implementation recommend the use of rapid diagnostic tests (RDT) that include active ASP interventions as one such approach to improve clinical outcomes and reduce inappropriate antimicrobial use.
A recently published official statement from the Society of Infectious Diseases Pharmacists (SIDP) highlighted the role of antimicrobial stewardship team in the use of rapid diagnostic testing in acute care. This statement outlined several important areas in which antimicrobial stewardship team members should focus during the implementation process in order to make the use of RDT impactful.
Collaboration with Microbiology Team
To make implementation of RDT a seamless process, antimicrobials stewardship team should engage the microbiology team in all phases of implementation. During the pre-implementation phase, antimicrobial stewardship and microbiology teams should jointly evaluate the RDT needs of the hospital based on factors such as bed size, hospital and community resistance patterns. When an RDT is in the implementation phase, microbiology and antimicrobial stewardship teams should be available to answer questions on RDT ordering process and interpretation of test results. During the post-implementation phase, RDT performance should be continually assessed and evaluated jointly by antimicrobial stewardship and microbiology teams to determine if a need for improvement exists.
Communication with Primary Team
Studies have shown that RDT are more impactful when they are facilitated by ASP. A meta-analysis by Timbrook, et al. including 31 studies with close to 6000 patients found that mortality risk was 34% lower when RDT was used to diagnosed bloodstream infections compared to conventional microbiology. Further analysis of the data revealed RDT only significantly reduced mortality risk when combined with ASP notification process (e.g., notifying/discussion RDT results with providers) but not when implemented alone. In order to realize the full potential of RDT, it is important for the ASP team to be actively involved and communicate therapy guidance based on RDT results with prescribers promptly.
Tracking and Reporting Quality Metrics
Quality metrics should be appropriately identified, tracked, and reported in order to demonstrate the value of RDT to both hospital clinicians and leadership. Tracking of quality metrics can also identify opportunities for improvement. Quality metrics can include clinical outcome metrics such as reduction in time to appropriate therapy, mortality, and length of hospital stay; and cost saving metrics such as reduction in costs associated with infection control, antimicrobial use, and additional laboratory tests.
Because the field of RDT is continuing to evolve as new clinical data and technologies become available, it is important for ASP team members to stay current on information in this area. Continuing education opportunities with a focus on RDT should be offered to ASP team members. ASP team members should in turn educate prescribers when new RDT is implemented or changes to existing RDT occur.
The official statement from SIDP concluded by reiterating that RDT improve clinical outcomes when combined with active involvement from ASP. The ASP pharmacists and physicians should serve as content experts supporting implementation of RDT, improvement in communications between microbiology and clinicians, and interpretation of RDT results to provide therapy guidance such that RDT can be used optimally to improve patient care.
For examples of rapid diagnostic tests interpretation guidance, please visit the Nebraska Medicine Antimicrobial Stewardship internet page at https://www.nebraskamed.com/for-providers/asp/clinical-microbiology.
Written by Phil Chung, PharmD, MS, BCPS