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FIGURE 4
CDSS and real-time feedback
Electronic prescribing records
Microbiology laboratory
Clinical observations
Hospital systems
in local bacterial , fungal or viral epidemiology and phenotypic resistance mechanisms can be reported and used to change empiric treatment pathways . Antibiograms , the summary of antimicrobial susceptibilities of local bacterial isolates , are an essential resource of antimicrobial stewardship teams when introducing new empiric guidelines , deciding on appropriate individual patient escalation / descalation plans and monitoring local resistance changes . Linking the microbiology diagnostic testing with patient records allows for more targeted antibiograms and subsequent tailoring of antimicrobial guidelines to high-risk patient groups ( for example , Pseudomonas susceptibility testing in the ICU to guide local hospital-acquired / ventilator-acquired pneumonia empiric guidelines ).
VODI and CDSS The advent of clinical decision support systems ( CDSS ) sees the further evolution of the antibiogram to provide real-time feedback for clinicians at time of prescribing . Here , CDSS can identify real-time mismatches of drug / bug prescribing based on a patient ’ s historic microbiology results and consequently trigger a patient-specific treatment plan . These systems build capabilities for AMS teams to better identify patients for review . This real-time feedback improves antimicrobial prescribing and mitigates the risk of AMR at a patient level ( Figure 4 , and see the next chapter in this handbook ).
VODI and public health At population level , aggregate diagnostic testing data can be transformed through epidemiology
Drug / bug mismatch
Drug toxicity
Audit and research
Epidemiology
New resistant organism
Appropriate use of antimicrobials
Patient-level intervention
Antimicrobial use surveillance
Patient outcome measures
Organisational-level intervention
software that can give instant , visual insights into pathogen circulation trends , and can be used to influence public health policy . Coordinated reporting from centralised laboratories to a national reference lab can provide the capabilities for Public Health bodies to monitor emerging infectious disease . Highly transmittable infections , such as measles or whooping cough , and enteric pathogens due to contaminated food produce , can be identified promptly and local teams alerted . 8
The SARS-CoV-2 pandemic has highlighted the societal benefits of a national reporting system which links local laboratory data to a central hub . Real-time disease incidence can be reported and inform national priorities and response . For instance , the UK National Health Service ( NHS ) labs reporting on SARS-CoV-2 PCR results underpinned the national COVID-19 response for 2020 / 21 and underlined this resource ’ s importance for public health . 9
Conclusion Antimicrobial resistance has a major clinical and economic impact upon healthcare services . The laboratory plays an essential role in timely identification of these pathogens and informing treatment decision making . These data support AMS activities , enabling the development of robust empiric prescribing guidelines , helping to target antimicrobial stewardship interventions and supporting personalised antimicrobial treatment plans at a patient level . Through greater diagnostic certainty , unnecessary antimicrobial prescribing can be reduced and targeted therapies initiated more appropriately to improve patient outcomes .
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