10 | VALUE OF DIAGNOSTICS THROUGHOUT THE PATIENT PATHWAY | 2021
Role of diagnostic testing in triage pathway to identify patients without infection and not requiring antimicrobials
Triage population ( n )
Treated with empirical antimicrobials
Triage population ( n )
Treated with targeted antimicrobials
No antimicrobials prescribed
Role of diagnostic testing in triage pathway to optimise antimicrobial prescribing
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