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Antibiotics
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Key Collaborations between Antimicrobial Stewardship & Clinical Microbiology – Focus...
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Key Collaborations between Antimicrobial Stewardship & Clinical Microbiology – Focus on Diagnostic Stewardship

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (15 December 2021) | Viewed by 16351

Special Issue Editor

Dr. Kimberly Claeys

E-Mail Website
Guest Editor
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
Interests: antimicrobial stewardship; diagnostic stewardship; drug-resistant gram-negatives; rapid diagnostics (particular in gram-negative infections).

Special Issue Information

Dear Colleagues,

The goal of antimicrobial stewardship programs (ASPs) is to optimize the use of antimicrobial therapy for individual patients and the population at large. Many programs rely on two main types of interventions: antibiotic restriction as well as prospective audit and feedback. Often, both interventions occur after a diagnostic test has been ordered and/or performed. ASPs are also inherently multidisciplinary, often lead by physicians and pharmacists trained in infectious diseases. The critical role of the clinical microbiology laboratory, however, is increasingly being recognized as the novel concept of diagnostic stewardship becomes more familiar to practitioners. Diagnostic stewardship aims to promote the appropriate use of diagnostic tests through the phases or ordering, collecting, testing, and reporting, and has been shown to have a profound impact on downstream antimicrobial prescribing.

This Special Issue, under antibiotic use and antimicrobial stewardship, will consist of manuscripts that promote the collaboration of ASP programs and clinical microbiology and highlight the importance of disseminating best practices related to diagnostic stewardship. Consideration of various infectious sources, intervention types, and practice settings is key. Articles may be in the form of original research, review articles, or opinion papers.

Dr. Kimberly Claeys
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • antimicrobial utilization
  • clinical microbiology
  • diagnostic stewardship
  • diagnostic testing

Published Papers (4 papers)

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Research

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10 pages, 839 KiB  
Article
Real Life Clinical Impact of Antimicrobial Stewardship Actions on the Blood Culture Workflow from a Microbiology Laboratory
by Jose Maria López-Pintor, Javier Sánchez-López, Carolina Navarro-San Francisco, Ana Maria Sánchez-Díaz, Elena Loza and Rafael Cantón
Antibiotics 2021, 10(12), 1511; https://doi.org/10.3390/antibiotics10121511 - 9 Dec 2021
Cited by 1 | Viewed by 2305
Abstract
Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of [...] Read more.
Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of a rapid blood culture workflow protocol in positive blood cultures with Gram-negative bacilli (GNB). Methods: A quasi-experimental before–after study was performed with two groups: (i) control group (conventional work-protocol) and (ii) intervention group (rapid workflow-protocol: rapid identification by Matrix-Assisted Laser Desorption/Ionization-Time-Of-Flight (MALDI-TOF) and antimicrobial susceptibility testing (AST) from bacterial pellet without overnight incubation). Patients were divided into different categories according to the type of intervention over treatment. Outcomes were compared between both groups. Results: A total of 313 patients with GNB-bacteremia were included: 125 patients in the control group and 188 in the intervention. The time from positive blood culture to intervention on antibiotic treatment decreased from 2.0 days in the control group to 1.0 in the intervention group (p < 0.001). On the maintenance of correct empirical treatment, the control group reported 2.0 median days until the clinical decision, while in the intervention group was 1.0 (p < 0.001). In the case of treatment de-escalation, a significant difference between both groups (4.0 vs. 2.0, p < 0.001) was found. A decreasing trend on the change from inappropriate treatments to appropriate ones was observed: 3.5 vs. 1.5; p = 0.12. No significant differences were found between both groups on 7-days mortality or on readmissions in the first 30-days. Conclusions: Routine implementation of a rapid workflow protocol anticipates the report of antimicrobial susceptibility testing results in patients with GNB-bacteremia, decreasing the time to effective and optimal antibiotic therapy. Full article
(This article belongs to the Special Issue Key Collaborations between Antimicrobial Stewardship & Clinical Microbiology – Focus on Diagnostic Stewardship)
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Review

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10 pages, 738 KiB  
Review
Antimicrobial Stewardship Programs: A Review of Strategies to Avoid Polymyxins and Carbapenems Misuse in Low Middle-Income Countries
by Fabrício Rodrigues Torres de Carvalho, João Paulo Telles, Felipe Francisco Bodan Tuon, Roberto Rabello Filho, Pedro Caruso and Thiago Domingos Correa
Antibiotics 2022, 11(3), 378; https://doi.org/10.3390/antibiotics11030378 - 12 Mar 2022
Cited by 5 | Viewed by 2781
Abstract
Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to [...] Read more.
Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to spare the prescription of polymyxins and carbapenems for the treatment of Acinetobacter baumannii, carbapenem-resistant Enterobacterales, and Pseudomonas aeruginosas infections. Additionally, we highlight how to implement cumulative antibiograms and biomarkers to a sooner de-escalation of antibiotics. Full article
(This article belongs to the Special Issue Key Collaborations between Antimicrobial Stewardship & Clinical Microbiology – Focus on Diagnostic Stewardship)
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13 pages, 771 KiB  
Review
Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement
by Kyle D. Hueth, Andrea M. Prinzi and Tristan T. Timbrook
Antibiotics 2022, 11(2), 250; https://doi.org/10.3390/antibiotics11020250 - 15 Feb 2022
Cited by 21 | Viewed by 5768
Abstract
Diagnostic stewardship aims to deliver the right test to the right patient at the right time and is optimally combined with antimicrobial stewardship to allow for the right interpretation to translate into the right antimicrobial at the right time. Laboratorians, physicians, pharmacists, and [...] Read more.
Diagnostic stewardship aims to deliver the right test to the right patient at the right time and is optimally combined with antimicrobial stewardship to allow for the right interpretation to translate into the right antimicrobial at the right time. Laboratorians, physicians, pharmacists, and other healthcare providers have an opportunity to improve the effectiveness of diagnostics through collaborative activities around pre-analytical and post-analytical periods of diagnostic testing. Additionally, special considerations should be given to measuring the effectiveness of diagnostics over time. Herein, we perform a narrative review of the literature on these potential optimization opportunities and the temporal factors that can yield changes in diagnostic effectiveness. Our objective is to inform on these considerations to ensure enhanced value through improved implementation and measurement of effectiveness for local stakeholder metrics and/or clinical outcomes research. Full article
(This article belongs to the Special Issue Key Collaborations between Antimicrobial Stewardship & Clinical Microbiology – Focus on Diagnostic Stewardship)
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Other

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17 pages, 822 KiB  
Systematic Review
Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections
by Faiza Morado and Darren W. Wong
Antibiotics 2022, 11(3), 308; https://doi.org/10.3390/antibiotics11030308 - 24 Feb 2022
Cited by 14 | Viewed by 4457
Abstract
A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics [...] Read more.
A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics often inappropriately ordered for non-specific symptoms or asymptomatic bacteriuria. In an attempt to limit unnecessary laboratory testing and antibiotic overutilization, several diagnostic stewardship initiatives have been described in the literature. We conducted a systematic review with a focus on the application of molecular and microbiological diagnostics, clinical decision support, and implementation of diagnostic stewardship initiatives for urinary tract infections. The most successful strategies utilized a bundled, multidisciplinary, and multimodal approach involving nursing and physician education and feedback, indication requirements for urine culture orders, reflex urine culture programs, cascade reporting, and urinary antibiograms. Implementation of antibiotic stewardship initiatives across the various phases of laboratory testing (i.e., pre-analytic, analytic, post-analytic) can effectively decrease the rate of inappropriate ordering of urine cultures and antibiotic prescribing in patients with clinically ambiguous symptoms that are unlikely to be a urinary tract infection. Full article
(This article belongs to the Special Issue Key Collaborations between Antimicrobial Stewardship & Clinical Microbiology – Focus on Diagnostic Stewardship)
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