ABSTRACT

Introduction: New diagnostics may be useful in clinical practice, especially in contexts of high prevalence of multidrug-resistant organisms (MDRO). However, misuse of diagnostic tools may lead to increased costs and worse patient outcome. Conventional and new techniques should be appropriately positioned in diagnostic algorithms to guide an appropriate use of antimicrobial therapy.

Areas covered: A panel of experts identified 4 main areas in which the implementation of diagnostic stewardship is needed. Among chronic infections, bone and prosthetic joint infections and subacute-chronic intravascular infections and endocarditis represent common challenges for clinicians. Among acute infections, bloodstream infections and community-acquired pneumonia may be associated with high mortality and require appropriate diagnostic approach.

Expert opinion: Diagnostic stewardship aims to improve the appropriate use of microbiological diagnostics to guide therapeutic decisions through appropriate and timely diagnostic testing. Here, diagnostic algorithms based on different patient profiles are proposed for chronic and acute clinical syndromes. In each clinical scenario, combining conventional and new diagnostic techniques is crucial to make a rapid and accurate diagnosis and to guide the selection of antimicrobial therapy. Barriers related to the implementation of new rapid diagnostic tools, such as high initial costs, may be overcome through their rational and structured use.

摘要

简介：新的诊断方法可能在临床实践中有用，特别是在多重耐药菌 (MDRO) 高流行的情况下。然而，误用诊断工具可能会导致成本增加和患者预后更差。传统技术和新技术应在诊断算法中适当定位，以指导抗菌治疗的适当使用。

涵盖的领域：专家小组确定了需要实施诊断管理的 4 个主要领域。在慢性感染中，骨和人工关节感染以及亚急性-慢性血管内感染和心内膜炎是临床医生面临的共同挑战。在急性感染中，血流感染和社区获得性肺炎可能与高死亡率相关，需要适当的诊断方法。

专家意见：诊断管理旨在通过适当和及时的诊断测试改进微生物诊断的适当使用，以指导治疗决策。在这里，针对慢性和急性临床综合征提出了基于不同患者特征的诊断算法。在每种临床情况下，结合传统诊断技术和新诊断技术对于做出快速准确的诊断和指导抗菌治疗的选择至关重要。与实施新的快速诊断工具相关的障碍，例如高昂的初始成本，可以通过合理和结构化的使用来克服。