Diagnostic Stewardship in Antimicrobial Stewardships
Crisel Margaret B. Machuca, M.D.
Introduction
On a global scale,infections are a leadingcontributor to morbidity and mortality.Use of diagnostictests for patients with suspected infections are known toimprove patient care. Hence,there has been anincreasing use of acute phase reactants (APRs)to guide treatment of infections since the presence of these markers signify injury and inflammation.’
According to Zakhour et al there has been anoveruse of diagnostic tests,particularly in patients whoare critically ill or immunocompromised.² The overuse oftests applies even to mild infections where unnecessarytesting lead to an appropriate treatment for colonizersdentified through culture.Diagnostic stewardship plays akey role to help physicians request the right tests for theright patient at the right time.This involves providingcoordinated guidance and interventions to ensure thattests especially cultures,are used appropriately andpromptly to produce clinically relevant results. This guides medical decisions, while also conserving healthcare resources.Diagnostic stewardship thereforeserves as a complement to Antimicrobial Stewardship(AMS).³
The objective of this review is to look intoDiagnostic Stewardship as a component of AntimicrobialStewardship.The discussion will focus on the use ofinflammatory markers including erythrocytesedimentation rate(ESR),C-Reactive Protein (CRP),andprocalcitonin. The role of blood culture and a PCR based pneumonia panel in will also be examined.