CDSS and real-time feedback
Electronic prescribing records
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
Audit and research
New resistant organism
Appropriate use of antimicrobials
Antimicrobial use surveillance
Patient outcome measures
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 .
References 1 World Health Organization . Second WHO modern list of essential in vitro diagnostics . 2019 . www . who . int / medical _ devices / publications / Standalone _ document _ v8 . pdf ? ua = 1 2 Lippi G , Plebani M . Laboratory medicine does matter in science ( and medicine )... yet many seem to ignore it . Clin Chem Lab Med 2015 ; 53 ( 11 ): 1655 – 6 . 3 Ngo A , Gandhi P , Miller WG . Frequency that laboratory tests influence medical decisions . J Appl Lab Med 2017 ; 1 ( 4 ): 410 – 4 . 4 O ’ Neill J . Tackling drug-resistant infections globally . 2016 . https :// amrreview . org / sites / default / files / 160518 _ Final % 20 paper _ with % 20cover . pdf ( accessed May 2021 ) 5 King ’ s Fund . Tackling variations in clinical care – assessing the Getting it Right First Time programme . [ online ] www . kingsfund . org . uk / publications / tacklingvariations-clinical-care ( accessed May 2021 ). 6 Gibani MM et al . Assessing a novel , lab-free , point of care test for SARS- CoV-2 ( CovidNudge ): a diagnostic accuracy study . Lancet 2020 ; 1 ( 7 ): E300 – E307 . 7 Wurcel V et al . The value of diagnostic information in personalised healthcare : A comprehensive concept to facilitate bringing this technology into healthcare systems . Public Health Genomics 2019 ; 22 ( 1 – 2 ): 8 – 15 . 8 Public Health England . Laboratory confirmed cases of measles , rubella and mumps , England : January to March 2020 . 2020 . https :// assets . publishing . service . gov . uk / government / uploads / system / uploads / attachment _ data / file / 887271 / hpr1020 _ MMR . pdf ( accessed May 2021 ) 9 Public Health England . Coronavirus ( COVID-19 ) in the UK . 2021 . https :// coronavirus . data . gov . uk / ( accessed May 2021 ).