• The importance of diagnostic stewardship in management of antimicrobial resistance
  • Mona Mohammadzadeh,1 Mohammad Rahbar,2 Marjan Rahnamaye Farzami,3,*
    1. Reference Health Laboratory (RHL), Ministry of Health and Medical Education.
    2. Reference Health Laboratory (RHL), Ministry of Health and Medical Education.
    3. Reference Health Laboratory (RHL), Ministry of Health and Medical Education.


  • Introduction: Antimicrobial resistance (AMR) is known as a global threat with the forecast of 10 million deaths per year globally by 2050. AMR has occurred due to widespread use, overuse and misuse of antimicrobial agents, particularly the inappropriate usage of antibiotics and spread from one country to the other faster than previously thought. AMR, which known as "Silent Pandemic" requires urgent actions and should be managed more effectively immediately. There are several global health organizations and governments to manage the threat of AMR. Global Action Plan (GAP-AMR) followed by launching the Global Antimicrobial Resistance and Use Surveillance System (GLASS) were established by the World Health Organization (WHO) in response to AMR. AMR affects human, environmental and animal health and requires the "One Health Approach". The "One Health Approach" which originated in the 19th century, is defined as a collective effort to provide solutions for human, animal and environmental health. One of the other key component for managing this global crisis and combat multidrug resistance microorganisms, is diagnostic stewardship (DS). DS as a key approach optimizes testing to reduce diagnostic error. Misdiagnosis occurs when a diagnosis test is missed, inaccurate, imprecise or incomplete. Thus, appropriate use of diagnostic tests can be gained by understanding the specific test performance benefits and limitations, which is best accomplished through DS. DS is a systematic approach to the effective use of the microbiology laboratory in order to performing and reporting diagnostic test including specimen collection, and pathogen identification results to reduce diagnostic error and improve the accuracy of clinical diagnosis, treatment, and intervention. These steps are referred to as pre analytical, analytical and post analytical phases. DS can be understood as the better diagnosis, more targeted and effective therapy can be initiated in clinical practice in order to deliver safer, more effective and efficient patient care by appropriate and timely generation of clinically relevant microbiological data. The medical microbiology laboratory plays a critical role in diagnosis of infectious diseases and this required a close and positive working relationship between physician and microbiology laboratories which provide enormous value to the health care team. Recent advances in diagnosis of microorganism provide clinician useful information about microorganism's identification and their resistance to antimicrobial agents. DS is an integral part of antibiotic stewardship program and needs to reliable microbiological diagnosis. Patient management includes correct diagnosis, appropriate treatment and infection and prevention control that can have the best outcome for the patient. DS must institutionalized the optimal strategy for testing that minimizes over diagnosis and unnecessary treatment without putting critical patients at risk, because reducing unnecessary testing decreases the occurrence of unnecessary treatment, but might increase the risk of delaying diagnosis and appropriate treatment of infections. DS enables early discontinuation of antibiotic treatment, thereby limiting the risk of antimicrobial resistance and improving clinical outcomes while reducing overuse of unnecessary drugs, costs, and medication-related adverse events, it also helps to improve surveillance data. To succeed in this way, good laboratory practices and appropriate access to quality laboratories, as well as the capacity and capability to perform reliable microbiological tests are essential. A correct and principled approach to testing, generates accurate and representative antimicrobial resistance surveillance data to inform antimicrobial resistance control strategies. Accurate and timely results help physicians to prescribe the most appropriate antibiotics for patients. In addition, data from the use of diagnostic pathway, can contribute to WHO antimicrobial surveillance is called GLASS - A guide to planning, implementation, monitoring and evaluation. DS is core component of antimicrobial resistance surveillance in humans as well as in the overall antimicrobial resistance control strategy. If appropriate antimicrobial treatment is delayed, it increases the mortality rate in many instances. Since timely initiation of appropriate antimicrobial treatment, is mainly prevented by the long turnaround time of standard culturing techniques, identification and susceptibility testing, new techniques such as molecular tests reduce time to identification and may even detect antimicrobial resistance pattern.
  • Methods: The manuscript is a review, so it does not have a methodology.
  • Results: The manuscript is a review, so it does not have results.
  • Conclusion: The use of diagnostic stewardship should be institutionalized in medical microbiology laboratory to reduce unnecessary testing, false positive results and to identify pathogens and their antimicrobial susceptibility as quickly as possible to improve patient care. Diagnostic stewardship should facilitate the conditions for physicians to make appropriate clinical decisions.
  • Keywords: Antimicrobial resistance. diagnostic stewardship. medical microbiology