Abstract

BackgroundRapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians’ endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians’ beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care.MethodsWe conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians’ beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically.ResultsClinicians’ beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians’ prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device’s capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results.ConclusionsClinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests’ capabilities and integration into clinical practice. Implementation strategies should bolster users’ necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests’ purpose and benefits, identifying and addressing clinicians’ misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60–90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.

Highlights

  • Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs)

  • Such tests may be useful in intensive care units (ICUs), where patients with pneumonia are frequent [2, 3], there is an increase the risk of rapid deterioration and death [3, 4], and there is a demand for urgent antimicrobial treatment [5, 6]

  • This approach is improvable because: (a) unnecessary antibiotics increase the risk of adverse consequences including direct toxicity, drug interactions, and Clostridium difficile infection [7], (b) empirical cover may prove ineffective for patients with drug resistant organisms [8], and (c) liberal broad-spectrum use drives antimicrobial resistance (AMR)

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Summary

Introduction

Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Recommended practice for a suspected pneumonia include the prescription of empiric broad-spectrum antibiotics, with refinement once results of laboratory cultures become available (typically after 48–72 h) [5] This approach is improvable because: (a) unnecessary antibiotics increase the risk of adverse consequences including direct toxicity, drug interactions, and Clostridium difficile infection [7], (b) empirical cover may prove ineffective for patients with drug resistant organisms [8], and (c) liberal broad-spectrum use drives antimicrobial resistance (AMR)

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