10 | VALUE OF DIAGNOSTICS THROUGHOUT THE PATIENT PATHWAY | 2021
FIGURE 1
Role of diagnostic testing in triage pathway to identify patients without infection and not requiring antimicrobials
Triage population ( n ) |
|
Diagnosis unconfirmed |
Treated with empirical antimicrobials |
Triage population ( n ) |
Diagnostic test |
Diagnosis confirmed
Diagnosis excluded
|
Treated with targeted antimicrobials
No antimicrobials prescribed
|
FIGURE 2
Role of diagnostic testing in triage pathway to optimise antimicrobial prescribing
Diagnosis confirmed |
Diagnostic test |
Pathogen identification
Detection of antimicrobial resistance mechanism
|
Treatment with appropriate antimicrobials |
Diagnostic testing to support antimicrobial stewardship ( AMS ) strategies For the management of infection ( bacterial , fungal or viral ), access to rapid , accurate and costeffective diagnostic testing is an essential criterion for improving patient outcomes . 2 In healthcare settings , patients can present with non-specific signs and symptoms in which an infectious aetiology can be present . Due to the known complications of delayed or missed treatment of severe bacterial infections , healthcare professionals will typically err on the side of caution and initiate empiric antimicrobial therapy as a ‘ just in case ’ option . Confirmation of a causative pathogen , whether bacterial , fungal or viral , is typically not made and empirical antimicrobial treatment will continue for the standard treatment course .
The growing pressure to protect antimicrobials in the face of rising antimicrobial resistance ( AMR ) is well established . Increased antimicrobial prescribing is placing a high selective pressure at both patient and a societal level to drive the development of antimicrobial resistant pathogens . 4 AMR is a global health risk as increasing resistance means many infections are becoming untreatable and procedures such as surgery and oncology therapies encounter more infective complications . Much of the antimicrobial prescribing is based on diagnosis of suspected , but unconfirmed , bacterial infections . This best guess , or ‘ empirical ’ management of bacterial infections results in unnecessary antimicrobial usage for patients with non-bacterial presentations and treatment failures in patients with inappropriate drug / bug matching ( for example , intrinsic or acquired antimicrobial resistance ).
Optimising patient outcomes with diagnostic testing Access to timely , reliable and cost-effective diagnostic tests can improve the triage of patients presenting with suspected or confirmed bacterial infection and reduce the uncertainty in the initial management of infection . 4 Diagnostic tests help clinicians identify the causative pathogen and any common antimicrobial resistance mechanisms present ( Figure 1 ). This supports clinicians in making more certain diagnoses and being more confident in their treatment decisions . It also aids