The Present and Future State of Antimicrobial Stewardship and Rapid Diagnostic Testing: Can One Ideally Succeed Without the Other?

Abstract

Purpose of reviewThe growth and development of rapid diagnostic technologies (RDTs) in infectious diseases (ID) have grown significantly over the past several years. The aim of these platforms is to identify causative pathogens more quickly and target antimicrobial therapy earlier, ultimately improving patient outcomes. Use of RDT specifically from blood specimens to optimize antimicrobial therapy and improve patient outcomes is a recommendation by the most recent antimicrobial stewardship (AMS) guidelines. In this review, we aim to highlight currently available FDA-approved RDTs for clinicians, data supporting the role of blood culture RDT platforms in AMS and their integration into clinical practice with and without AMS support to improve patient outcomes, as well as potential future opportunities for current and pending platforms.Recent findingsNew RDT platforms continue to enter the market, most recently with GenMark’s ePlex Gram-positive and fungal panels. The Accelerate Pheno™ technology is unique in its ability to provide identification and phenotypic susceptibility results for pathogens included in its platform within 7 h. We anticipate more RDTs will continue to enter the market in the coming years. Across published literature, it has been shown the most significant impact in optimization of antimicrobial therapy occurs with integration of RDT with AMS intervention. Additionally, a recent meta-analysis showed a decreased mortality risk with use of RDT with AMS programs. Despite the perceived benefit of RDT, cost can be a major obstacle for institutions and data on the fiscal impact and associated return on investment are still needed.SummaryRapid diagnostics in ID and AMS programs continue to grow. Data has shown the benefit of RDTs with AMS intervention, especially in the realm of positive blood cultures. Expansion of RDTs in all culture sites continues to be a need for patients as well as further literature to justify the high costs for these technologies.