1887

Abstract

The term ‘diagnostic stewardship’ is relatively new, with a recent surge in its use within the literature. Despite its increasing popularity, a precise definition remains elusive. Various attempts have been made to define it, with some viewing it as an integral part of antimicrobial stewardship. The World Health Organization offers a broad definition, emphasizing the importance of timely, accurate diagnostics. However, inconsistencies in the use of this term still persist, necessitating further clarification.

There are currently inconsistencies in the definition of diagnostic stewardship used within the academic literature.

This scoping review aims to categorize the use of diagnostic stewardship approaches and define this approach by identifying common characteristics and factors of its use within the literature.

This scoping review undertook a multi-database search from date of inception until October 2022. Any observational or experimental study where the authors define the intervention to be diagnostic stewardship from any clinical area was included. Screening of all papers was undertaken by a single reviewer with 10% verification by a second reviewer. Data extraction was undertaken by a single reviewer using a pre-piloted form. Given the wide variation in study design and intervention outcomes, a narrative synthesis approach was applied. Studies were clustered around common diagnostic stewardship interventions where appropriate.

After duplicate removal, a total of 1310 citations were identified, of which, after full-paper screening, 105 studies were included in this scoping review. The classification of an intervention as taking a diagnostic stewardship approach is a relatively recent development, with the first publication in this field dating back to 2017. The majority of research in this area has been conducted within the USA, with very few studies undertaken outside this region. Visual inspection of the citation map reveals that the current evidence base is interconnected, with frequent references to each other’s work. The interventions commonly adopt a restrictive approach, utilizing hard and soft stops within the pre-analytical phase to restrict access to testing. Upon closer examination of the outcomes, it becomes evident that there is a predominant focus on reducing the number of tests rather than enhancing the current test protocol. This is further reflected in the limited number of studies that report on test performance (including protocol improvements, specificity and sensitivity).

Diagnostic stewardship seems to have deviated from its intended course, morphing into a rather rudimentary instrument wielded not to enhance but to constrict the scope of testing. Despite the World Health Organization’s advocacy for an ideology that promotes a more comprehensive approach to quality improvement, it may be more appropriate to consider alternative regional narratives when categorizing these types of quality improvement interventions.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001831
2024-05-09
2024-05-23
Loading full text...

Full text loading...

/deliver/fulltext/jmm/73/5/jmm001831.html?itemId=/content/journal/jmm/10.1099/jmm.0.001831&mimeType=html&fmt=ahah

References

  1. Stokel-Walker C. What can be done to ease today’s pressures in the NHS?. BMJ 2023; 380:88 [View Article] [PubMed]
    [Google Scholar]
  2. The Royal College of Pathologists Meeting pathology dem and Histopathology workforce census; 2018
  3. HM Government COVID-19 response: living with COVID-19; 2022
  4. Healthtrust Europe Bridging the Resourcing gap in the NHS; 2019
  5. Rawlins M. In pursuit of quality: the National Institute for Clinical Excellence. Lancet 1999; 353:1079–1082 [View Article] [PubMed]
    [Google Scholar]
  6. Wickens C. Why do diagnostics matter? Maximising the potential of diagnostics services; 2022
  7. Hueth KD, Prinzi AM, Timbrook TT. Diagnostic Stewardship as a team sport: interdisciplinary perspectives on improved implementation of interventions and effect measurement. Antibiotics 2022; 11:250 [View Article] [PubMed]
    [Google Scholar]
  8. Claeys KC, Johnson MD. Leveraging diagnostic stewardship within antimicrobial stewardship programmes. Drugs Context 2023; 12:2022-9-5 [View Article] [PubMed]
    [Google Scholar]
  9. Dyar OJ, Moran-Gilad J, Greub G, Pulcini C. ESGMD Executive Committee and the ESGAP Executive Committee Diagnostic stewardship: are we using the right term?. Clin Microbiol Infect 2019; 25:272–273 [View Article] [PubMed]
    [Google Scholar]
  10. National Institute for Health and Care Excellence Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use; 2015
  11. Shrestha JZF, Cannady J. Antimicrobial stewardship. In StatPearls Treasure Island (FL): StatPearls; 2023
    [Google Scholar]
  12. Dryden M, Johnson AP, Ashiru-Oredope D, Sharland M. Using antibiotics responsibly: right drug, right time, right dose, right duration. J Antimicrob Chemother 2011; 66:2441–2443 [View Article] [PubMed]
    [Google Scholar]
  13. Morgan DJ, Malani P, Diekema DJ. Diagnostic stewardship-leveraging the laboratory to improve antimicrobial use. JAMA 2017; 318:607–608 [View Article] [PubMed]
    [Google Scholar]
  14. Sullivan KV. Diagnostic stewardship in clinical microbiology, essential partner to antimicrobial stewardship. Clin Chem 2021; 68:75–82 [View Article] [PubMed]
    [Google Scholar]
  15. Tiseo G, Arena F, Borrè S, Campanile F, Falcone M et al. Diagnostic stewardship based on patient profiles: differential approaches in acute versus chronic infectious syndromes. Expert Rev Anti Infect Ther 2021; 19:1373–1383 [View Article] [PubMed]
    [Google Scholar]
  16. Weragama K, Mudgil P, Whitehall J. Diagnostic stewardship-the impact of rapid diagnostic testing for paediatric respiratory presentations in the emergency setting: a systematic review. Children 2022; 9:1226 [View Article] [PubMed]
    [Google Scholar]
  17. Warren BG, Yarrington ME, Polage CR, Anderson DJ, Moehring RW. Evaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardship. Infect Control Hosp Epidemiol 2023; 44:200–205 [View Article] [PubMed]
    [Google Scholar]
  18. Green AL, Liang Y, O’Hara LM, Pineles L, Sorongon S et al. Follow-up blood cultures in Pseudomonas aeruginosa bacteremia: a potential target for diagnostic stewardship. Antimicrob Steward Healthc Epidemiol 2021; 1:e23 [View Article] [PubMed]
    [Google Scholar]
  19. Schinkel M, Boerman AW, Bennis FC, Minderhoud TC, Lie M et al. Diagnostic stewardship for blood cultures in the emergency department: a multicenter validation and prospective evaluation of a machine learning prediction tool. EBioMedicine 2022; 82:104176 [View Article] [PubMed]
    [Google Scholar]
  20. Woods-Hill CZ, Colantuoni EA, Koontz DW, Voskertchian A, Xie A et al. Association of diagnostic stewardship for blood cultures in critically Ill children with culture rates, antibiotic use, and patient outcomes: results of the bright STAR collaborative. JAMA Pediatr 2022; 176:690–698 [View Article] [PubMed]
    [Google Scholar]
  21. World Health Organisation Diagnostic stewardship: a guide to implementation in antimicrobial resistance surveillance sites; 2016
  22. Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D et al. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13:141–146 [View Article] [PubMed]
    [Google Scholar]
  23. Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci 2010; 5:69 [View Article] [PubMed]
    [Google Scholar]
  24. Polanin JR, Pigott TD, Espelage DL, Grotpeter JK. Best practice guidelines for abstract screening large‐evidence systematic reviews and meta‐analyses. Res Synth Methods 2019; 10:330–342 [View Article]
    [Google Scholar]
  25. Samarasundera E, Walsh T, Cheng T, Koenig A, Jattansingh K et al. Methods and tools for geographical mapping and analysis in primary health care. Prim Health Care Res Dev 2012; 13:10–21 [View Article] [PubMed]
    [Google Scholar]
  26. Litmap Discover the world of Scientific Literature 2023. n.d https://www.litmaps.com
  27. Madden GR, German Mesner I, Cox HL, Mathers AJ, Lyman JA et al. Reduced Clostridium difficile tests and laboratory-identified events with a computerized clinical decision support tool and financial incentive. Infect Control Hosp Epidemiol 2018; 39:737–740 [View Article] [PubMed]
    [Google Scholar]
  28. Shrestha J, Zahra F, Cannady JP. timicrobial Stewardship. In StatPearls vol 2023 Treasure Island (FL): StatPearls Publishing;
    [Google Scholar]
  29. Farge E, Revill J. “Test, test, test”: WHO chief’s coronavirus message to world 2020. n.d https://www.reuters.com/article/idUSKBN21331F/#:~:text=%22We%20have%20a%20simple%20message,cannot%20fight%20this%20pandemic%20blindfolded.%22
  30. Yen C, Holtom P, Butler-Wu SM, Wald-Dickler N, Shulman I et al. Reducing clostridium difficile colitis rates via cost-saving diagnostic stewardship. Infect Control Hosp Epidemiol 2018; 39:734–736 [View Article] [PubMed]
    [Google Scholar]
  31. Solanky D, Juang DK, Johns ST, Drobish IC, Mehta SR et al. Using diagnostic stewardship to reduce rates, healthcare expenditures and accurately identify cases of hospital-onset Clostridioides difficile infection. Infect Control Hosp Epidemiol 2021; 42:51–56 [View Article] [PubMed]
    [Google Scholar]
  32. American Board of Internal Medicine foundation Choosing Wisely®Promoting conversations between patients and clinicians; 2023 https://this3.org/what-we-do/choosing-wisely
  33. Abbas M, Vernaz N, von Dach E, Vuilleumier N, Harbarth SJ et al. Impact of restricting procalcitonin measurements in a Swiss tertiary-care hospital on antibiotic use, clinical outcomes, and costs: An interrupted time-series analysis. Infect Control Hosp Epidemiol 2021; 42:890–892 [View Article] [PubMed]
    [Google Scholar]
  34. Abbasi S, Singh F, Griffel M, Murphy PF. A process approach to decreasing hospital onset clostridium difficile infections. Jt Comm J Qual Patient Saf 2020; 46:146–152 [View Article] [PubMed]
    [Google Scholar]
  35. Acuña M, Benadof D, Yohannessen K, Leiva Y, Clement P. FilmArray® Meningoencephalitis panel in the diagnosis of central nervous system infections: stewardship and cost analysis in a paediatric hospital in Chile. BMC Pediatr 2022; 22:182 [View Article] [PubMed]
    [Google Scholar]
  36. Agarwal J, Singh V, Das A, Nath SS, Kumar R et al. Reversing the trend of antimicrobial resistance in ICU: role of antimicrobial and diagnostic stewardship. Indian J Crit Care Med 2021; 25:635–641 [View Article] [PubMed]
    [Google Scholar]
  37. Al-Bizri LA, Vahia AT, Rizvi K, Bardossy AC, Robinson PK et al. Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infect Control Hosp Epidemiol 2022; 43:1032–1035 [View Article] [PubMed]
    [Google Scholar]
  38. AlQahtani H, Alqahtani FY, Aleanizy FS, Baloch S, Tabb D. Impact of rapid identification of Staphylococcus species in positive blood culture using GeneXpert Methicillin-resistant Staphylococcus aureus/ Staphylococcus aureus blood culture assay combined with antibiotic stewardship. Microb Drug Resist 2021; 27:1037–1043 [View Article] [PubMed]
    [Google Scholar]
  39. Andrade M, Geffert S, Vickery L, Chapin K, McDougall M. Diagnostic stewardship: framework for development of best practices algorithm for hepatitis C testing. J Mol Diagn 2019; 21:1155
    [Google Scholar]
  40. Baghdadi J, Ganz DA, Chumpia M, Chang ET, de Peralta SS. Holding firm: use of clinical correlation to improve Clostridioides difficile testing. Am J Infect Control 2020; 48:1104–1107 [View Article] [PubMed]
    [Google Scholar]
  41. Abstracts from USCAP 2021 Neuropathology and ophthalmic pathology (848-862). Lab Invest 2021; 101:1056–1071 [View Article]
    [Google Scholar]
  42. Bettger CC, Giancola SE, Cybulski RJ, Okulicz JF, Barsoumian AE. Evaluation of a two step testing algorithm to improve diagnostic accuracy and stewardship of Clostridioides difficile infections. In Rev 2022 [View Article]
    [Google Scholar]
  43. Bianchini M, Mercuro N, Kenney R, Peters M, Swiderek J et al. Pharmacy-driven initiative improves care for severe community-acquired pneumonia. Crit Care Med 2019; 47:281 [View Article]
    [Google Scholar]
  44. Bilinskaya A, Goodlet KJ, Nailor MD. Evaluation of a best practice alert to reduce unnecessary Clostridium difficile testing following receipt of a laxative. Diagn Microbiol Infect Dis 2018; 92:50–55 [View Article] [PubMed]
    [Google Scholar]
  45. Bischoff W, Bubnov A, Palavecino E, Beardsley J, Williamson J et al. The impact of diagnostic stewardship on clostridium difficile infections. Open Forum Infect Dis 2017; 4:S398 [View Article]
    [Google Scholar]
  46. Block M, Henderson C, Arocha D, Reed M-G, Foster J et al. Reduction of C. difficile standardized infection ratio by limiting testing in patients with low probability of infection. Can J Infect Control 2018; 33:111–116
    [Google Scholar]
  47. Bradshaw AB, Bonnecaze AK, Burns CA, Beardsley JR. Impact of an interprofessional collaborative quality improvement initiative to decrease inappropriate thyroid function testing. Hosp Pharm 2021; 56:481–485 [View Article] [PubMed]
    [Google Scholar]
  48. Broadhurst MJ, Dujari S, Budvytiene I, Pinsky BA, Gold CA et al. Utilization, yield, and accuracy of the FilmArray Meningitis/Encephalitis panel with diagnostic stewardship and testing algorithm. J Clin Microbiol 2020; 58:24 [View Article] [PubMed]
    [Google Scholar]
  49. Broyles JL, Friberg E, Hall KK, DeGuzman PB. Diagnostic stewardship protocol to reduce urine contamination: a quality improvement project. J Nurse Pract 2021; 17:399–404 [View Article]
    [Google Scholar]
  50. Christensen AB, Barr VO, Martin DW, Anderson MM, Gibson AK et al. Diagnostic stewardship of C. difficile testing: a quasi-experimental antimicrobial stewardship study. Infect Control Hosp Epidemiol 2019; 40:269–275 [View Article] [PubMed]
    [Google Scholar]
  51. Church E, Neves CB, Moran J. Culture of culturing: utilizing an order set to effectively foster urine diagnostic stewardship in hospitalized patients with urinary catheters. Am J Infect Control 2018; 46:S14–S15 [View Article]
    [Google Scholar]
  52. Claeys KC, Zhan M, Pineles L, Lydecker A, Clore G et al. Conditional reflex to urine culture: evaluation of a diagnostic stewardship intervention within the veterans’ affairs and centers for disease control and prevention practice-based research network. Infect Control Hosp Epidemiol 2021; 42:176–181 [View Article] [PubMed]
    [Google Scholar]
  53. Dbeibo L, Brinkman A, Beeler C, Fadel W, Snyderman W et al. Utilizing a real-time discussion approach to improve the appropriateness of Clostridioides difficile testing and the potential unintended consequences of this strategy. Infect Control Hosp Epidemiol 2020; 41:1215–1218 [View Article] [PubMed]
    [Google Scholar]
  54. Deming S. CDIFFerently: a bundled approach to Clostridium difficile reduction. Infect Control Hosp Epidemiol 2020; 41:s156–s157 [View Article]
    [Google Scholar]
  55. Doll ME, Zhao J, Kang L, Rittmann B, Alvarez M et al. Chasing the rate: an interrupted time series analysis of interventions targeting reported hospital onset Clostridioides difficile, 2013-2018. Infect Control Hosp Epidemiol 2020; 41:1142–1147 [View Article] [PubMed]
    [Google Scholar]
  56. Dougherty DF, Rickwa J, Guy D, Keesee K, Martin BJ et al. Reducing inappropriate urine cultures through a culture standardization program. Am J Infect Control 2020; 48:656–662 [View Article] [PubMed]
    [Google Scholar]
  57. Elkafrawy AA, Tomaw A, Numan L, Saeed L, Kaddourah O et al. Improving the diagnostic stewardship of Clostridioides difficile infection in a health system. Am J Gastroenterol 2019; 114:S127–S128 [View Article]
    [Google Scholar]
  58. Fabre V, Klein E, Salinas AB, Jones G, Carroll KC et al. A diagnostic stewardship intervention to improve blood culture use among adult nonneutropenic inpatients: the distribute study. J Clin Microbiol 2020; 58:e01053-20 [View Article] [PubMed]
    [Google Scholar]
  59. Fabre V, Salinas A, Pleiss A, Zink E, Jones G et al. Implementation of diagnostic stewardship algorithms by bedside nurses to improve culturing practices: factors associated with success. Infect Control Hosp Epidemiol 2020; 41:s276–s277 [View Article]
    [Google Scholar]
  60. Fabre V, Pleiss A, Demko Z, Sick-Samuels A, Hicks L et al. Implementation of a diagnostic stewardship algorithm by bedside nurses to reduce unnecessary urinary cultures in hospitalized adult patients. Open Forum Infect Dis 2019; 6:S703–S704 [View Article] [PubMed]
    [Google Scholar]
  61. Farrell JJ, Bowers A. C. diff-erent results: eliminating inappropriate stool PCR tests through an interdisciplinary infection prevention and mirobiology collaboration. Open Forum Infect Dis 2019; 6:S808 [View Article]
    [Google Scholar]
  62. Friedland AE, Brown S, Glick DR, Lusby MC, Lemkin D et al. Use of computerized clinical decision support for diagnostic stewardship in Clostridioides difficile testing: an academic hospital quasi-experimental study. J Gen Intern Med 2019; 34:31–32 [View Article] [PubMed]
    [Google Scholar]
  63. Gupta A, Siddiqui F, Purwar S, Saigal S, Sharma JP et al. A Prospective Study to Improve Automated Blood Culture Diagnostics in Gram-Negative Sepsis by Implementing A “Diagnostic Stewardship Care-Bundle.”. Infect Dis 2022; 28: [View Article]
    [Google Scholar]
  64. Halabi KC, Ross B, Acker KP, Cannon J-M, Messina M et al. Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics. Infect Control Hosp Epidemiol 2023; 44:186–190 [View Article] [PubMed]
    [Google Scholar]
  65. Hayes JF, Lee RA, Camins B. The Impact of Bowel Management System (BMS) on the Incidence of Hospital-Onset (HO) Clostridium difficile infection laboratory-ID events despite diagnostic stewardship. Open Forum Infect Dis 2018; 5:S187 [View Article]
    [Google Scholar]
  66. Howard-Anderson JR, Ashraf S, Overton EC, Reif L, Murphy DJ et al. Sustained decrease in urine culture utilization after implementing a reflex urine culture intervention: a multicenter quasi-experimental study. Infect Control Hosp Epidemiol 2020; 41:369–371 [View Article] [PubMed]
    [Google Scholar]
  67. Jakharia K, Ilaiwy G, Moose S, Waga M, McAlduff J et al. Use of whole-genome sequencing to guide a C. difficile diagnostic stewardship program. Open Forum Infect Dis 2018; 5:S193 [View Article]
    [Google Scholar]
  68. Kang M, Abeles SR, El-Kareh R, Taplitz RA, Nyheim E et al. The effect of Clostridioides difficile diagnostic stewardship interventions on the dagnosis of hospital-onset Clostridioides difficile infections. Jt Comm J Qual Patient Saf 2020; 46:457–463 [View Article] [PubMed]
    [Google Scholar]
  69. Karaba AH, Blair PW, Martin K, Saheed MO, Carroll KC et al. The effects of a systemwide diagnostic stewardship change on West Nile virus disease ordering practices. Open Forum Infect Dis 2019; 6:ofz488 [View Article] [PubMed]
    [Google Scholar]
  70. Karlovich NS, Sata SS, Griffith B, Coop A, Kalu IC et al. In pursuit of the holy grail: improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction. Infect Control Hosp Epidemiol 2022; 43:840–847 [View Article] [PubMed]
    [Google Scholar]
  71. Kendall JA, Colson J, Saeed L, Mizusawa M, Yamamoto T. A diagnostic stewardship intervention to improve utilization of 1,3-β-D-glucan testing. Open Forum Infect Dis 2020; 7:S62 [View Article]
    [Google Scholar]
  72. Khuvis J, Alsoubani M, Mae Rodday A, Doron S. The impact of diagnostic stewardship interventions on Clostridiodes difficile test ordering practices and results. Clin Biochem 2023; 117:23–29 [View Article] [PubMed]
    [Google Scholar]
  73. Koll B, Patel G, Anderson R, Lopachin V. How to C a difference: a multidisciplinary approach to C. difficile. Int J Qual Health Care 2017; 29:39 [View Article]
    [Google Scholar]
  74. Koontz D, Woods-Hill C, Voskertchian A, Xie A, Miller M et al. Results of a multicenter diagnostic stewardship collaborative to optimize blood culture use in critically Ill children. ASHE 2021; 1:s27 [View Article]
    [Google Scholar]
  75. Kressel A, Cheatham M, Chang A. Diagnostic stewardship of respiratory pathogen panel utilization. ASHE 2021; 1:s59 [View Article]
    [Google Scholar]
  76. Kueht M, Kharsa A, Mujtaba M, Kulkarni R, Britt R et al. Antibiotic stewardship and inpatient Clostridioides difficile testing in solid organ transplant recipients: the need for multilevel checks and balances. Transplant Proc 2022; 54:605–609 [View Article] [PubMed]
    [Google Scholar]
  77. Kuhn RT, Johnson JL, Nelson V, Fitzpatrick D, Ahmad S et al. Impact of a two-step antimicrobial stewardship intervention on C. difficile infection diagnosis at an Urban Veteran’s affairs medical center. Open Forum Infect Dis 2019; 6:S813 [View Article]
    [Google Scholar]
  78. Kwon JH, Reske KA, Hink T, Jackups R, Burnham C-AD et al. Impact of an electronic hard-stop clinical decision support tool to limit repeat Clostridioides difficile toxin enzyme immunoassay testing on test utilization. Infect Control Hosp Epidemiol 2019; 40:1423–1426 [View Article] [PubMed]
    [Google Scholar]
  79. Lakshmi S, Atrubin K, Myers A, Teter J, Jariwala R et al. Incorporating electronic medical record hard stops to reduce inappropriate Clostridioides difficile testing at an academic medical center: a quality improvement study. Open Forum Infect Dis 2019; 6:S807–S808 [View Article]
    [Google Scholar]
  80. LaPorte MRC, Bruno-Murtha LA. Achieving and maintaining low rates of hospital-onset Clostridioides difficile. Infect Control Hosp Epidemiol 2020; 41:995–997 [View Article] [PubMed]
    [Google Scholar]
  81. Lau CE, Morse RG, Sifri C, Madden G. A randomized assessment of a laxative-based Clostridioides difficile diagnostic stewardship intervention. Infect Control Hosp Epidemiol 2020; 41:s102–s103 [View Article] [PubMed]
    [Google Scholar]
  82. Lee ALH, Leung ECM, Lee MKP, Lai RWM. Diagnostic stewardship programme for urine culture: impact on antimicrobial prescription in a multi-centre cohort. J Hosp Infect 2021; 108:81–89 [View Article] [PubMed]
    [Google Scholar]
  83. Lennon D, George R, Varadhan H. Impact of a diagnostic stewardship initiative of bacterial 16s rRNA sequencing referrals from a regional laboratory. Pathology 2021; 53:S51 [View Article]
    [Google Scholar]
  84. Lin G, Knowlson S, Nguyen H, Cooper K, Pryor RJ et al. Urine test stewardship for catheterized patients in the critical care setting: provider perceptions and impact of electronic order set interventions. Am J Infect Control 2019; 47:1277–1279 [View Article] [PubMed]
    [Google Scholar]
  85. Liu C, Lan K, Krantz EM, Kim HN, Zier J et al. Improving appropriate diagnosis of Clostridioides difficile infection through an enteric pathogen order set with computerized clinical decision support: an interrupted time series analysis. Open Forum Infect Dis 2020; 7:ofaa366 [View Article] [PubMed]
    [Google Scholar]
  86. Luu A, Dominguez F, Yeshoua B, Vo C, Nallapa S et al. Reducing catheter-associated urinary tract infections via cost-saving diagnostic stewardship. Clin Infect Dis 2021; 72:e883–e886 [View Article] [PubMed]
    [Google Scholar]
  87. Madden GR, Sifri CD. Reduced Clostridioides difficile tests among solid organ transplant recipients through a diagnostic stewardship bundled intervention. Ann Transplant 2019; 24:304–311 [View Article] [PubMed]
    [Google Scholar]
  88. Marcelin JR, Brewer C, Beachy M, Lyden E, Winterboer T et al. Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing. Infect Control Hosp Epidemiol 2019; 40:668–673 [View Article]
    [Google Scholar]
  89. Marchand-Senécal X, Brasg IA, Kozak R, Elligsen M, Vermeiren C et al. Impact of rejection of low-quality wound swabs on antimicrobial prescribing: a controlled before-after study. Open Forum Infect Dis 2021; 8:faa609 [View Article] [PubMed]
    [Google Scholar]
  90. Messacar K, Palmer C, Gregoire L, Elliott A, Ackley E et al. Clinical and financial impact of a diagnostic stewardship program for children with suspected central nervous system infection. J Pediatr 2022; 244:161–168 [View Article] [PubMed]
    [Google Scholar]
  91. Mizusawa M, Small BA, Hsu Y-J, Sharara SL, Advic E et al. Prescriber behavior in Clostridioides difficile testing: a 3-Hospital Diagnostic stewardship intervention. Clin Infect Dis 2019; 69:2019–2021 [View Article] [PubMed]
    [Google Scholar]
  92. Monsalud CF, Singh K, McElvania E, Schora D, Grant J et al. Modified laboratory reporting to prevent catheter-associated Urinary Tract Infections (CAUTIs). Open Forum Infect Dis 2020; 7:S447–S448 [View Article]
    [Google Scholar]
  93. Moss J, Forster DW, Arora V, Burgess D, Wallace K et al. A diagnostic stewardship intervention for Clostridioides difficile: impact of stool toxin testing on treatment of adult inpatients. Open Forum Infect Dis 2019; 6:S663 [View Article]
    [Google Scholar]
  94. Munigala S, Rojek R, Wood H, Yarbrough ML, Jackups RR et al. Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: analysis from a large academic medical center. Infect Control Hosp Epidemiol 2019; 40:281–286 [View Article] [PubMed]
    [Google Scholar]
  95. Nanda N, Vyas N. Leveraging information technology to hardwire diagnostic stewardship. J Med Diagn Meth 2018; 07:4 [View Article]
    [Google Scholar]
  96. Newman ME, Landon E, Bartlett A, Marrs R, Seguin A et al. An EMR-based diagnostic stewardship intervention for GI mPCR aimed at reducing inappropriate C. difficile tests. Open Forum Infect Dis 2018; 5:S194–S195 [View Article]
    [Google Scholar]
  97. Nix CD, Messer WB, Hale ML, Lewis JS, Strasfeld LM. Impact of a Clostridioides difficile testing computerized clinical decision support tool on an adult stem cell transplantation and Hematologic Malignancies Unit. Transplant Cell Ther 2021; 27:94 [View Article] [PubMed]
    [Google Scholar]
  98. Page S, Hazen D, Kelley K, Singh R, Rodgers RB et al. Changing the culture of urine culturing: utilizing agile implementation to improve diagnostic stewardship in the ICU. Am J Infect Control 2020; 48:1375–1380 [View Article] [PubMed]
    [Google Scholar]
  99. Penney J, Rodday A, Sebastiani P, Snydman D, Doron S. Effecting the culture: impact of changing urinalysis with reflex culture criteria on culture rates and outcomes. ASHE 2022; 2:s14 [View Article]
    [Google Scholar]
  100. Penney JA, Rodday AM, Sebastiani P, Snydman DR, Doron SI. Impact of provider-selected indication requirement on urine test utilization and positivity. Antimicrob Steward Healthc Epidemiol 2022; 2:e103 [View Article] [PubMed]
    [Google Scholar]
  101. Poelman R, der Meer J van, der Spek C van, Riezebos-Brilman A, Knoester M et al. Improved diagnostic policy for respiratory tract infections essential for patient management in the emergency department. Future Microbiol 2020; 15:623–632 [View Article] [PubMed]
    [Google Scholar]
  102. Prodanuk M, Foong Y, Singh V, Morrissey L, Science M et al. Pediatric urinary tract infections: a choosing wisely initiative to advance antimicrobial stewardship and diagnostic accuracy in the emergency department. Open Forum Infect Dis 2020; 7:S687–S688 [View Article]
    [Google Scholar]
  103. Qamar Z, Spacek LA, Coppock D, Patel K, L’Etoile N et al. Diagnostic stewardship of Clostridioides difficile testing. Open Forum Infect Dis 2021; 8: [View Article]
    [Google Scholar]
  104. Qutaishat S, Gibbons R. Diagnostic Stewardship for Clostridium Difficile Works! Reduction of Healthcare-Onset Rates, Vancomycin Use, and Contact Precaution SHEA Spring; 2018
    [Google Scholar]
  105. Rico M, Sulaiman R, MacLeod R. Asymptomatic bacteriuria: impact of an antimicrobial stewardship bundle to reduce unnecessary antibiotics in patients without urinary catheters. Am J Health-Syst Pharm 2021; 78:S83–S87 [View Article]
    [Google Scholar]
  106. Rock C, Abosi O, Bleasdale S, Colligan E, Diekema DJ et al. Clinical decision support systems to reduce unnecessary Clostridioides difficile testing across Multiple Hospitals. Clin Infect Dis 2022; 75:1187–1193 [View Article]
    [Google Scholar]
  107. Schultz K, Sickbert-Bennett E, Marx A, Weber DJ, DiBiase LM et al. Preventable patient harm: a multidisciplinary, bundled approach to reducing Clostridium difficile infections while using a glutamate dehydrogenase/toxin immunochromatographic assay/ucleic acid amplification test diagnostic algorithm. J Clin Microbiol 2018; 56:e00625-18 [View Article] [PubMed]
    [Google Scholar]
  108. Schwarz ER, Rana M, Chasan R, Gitman MR. T2Candida panel use evaluation: a quality improvement project. Open Forum Infect Dis 2020; 7:S59 [View Article]
    [Google Scholar]
  109. Scott L, Oppy L, Bishop S, Stevenson G, Garr J et al. EHR integrated urine culture algorithm is an effective diagnostic stewardship strategy. Am J Infect Control 2022; 50:S11 [View Article] [PubMed]
    [Google Scholar]
  110. Shallal A, Cherabuddi M, Podsiad L, Gortat C, Shanahan C et al. Role of diagnostic stewardship in reducing healthcare facility-onset Clostridioides difficile infections. ASHE 2022; 2:s28–s29 [View Article]
    [Google Scholar]
  111. Shields RK, Clancy CJ, Marini RV, Groetzinger L, Rivosecchi R et al. Incorporating T2Candida testing into rational antifungal (AF) management: a successful pilot study of diagnostic stewardship (DS) directed toward specific Intensive Care Unit (ICU) patients at-risk for sepsis due to invasive candidiasis (IC). Open Forum Infect Dis 2018; 5:S592–S593 [View Article]
    [Google Scholar]
  112. Sick-Samuels A, Bergmann J, Linz M, Fackler J, Berenholtz S et al. Reduction in endotracheal aspirate cultures after implementation of a diagnostic stewardship intervention in a Pediatric Intensive Care Unit. Open Forum Infect Dis 2019; 6:S61 [View Article]
    [Google Scholar]
  113. Sperling K, Priddy A, Suntharam N, Feuerhake T. Optimizing testing for Clostridium difficile infection: a quality improvement project. Am J Infect Control 2019; 47:340–342 [View Article] [PubMed]
    [Google Scholar]
  114. Sterling S, Sarah H, Kappus N, Reed A, Kramer P. Effectiveness of interventions targeting stewardship of Clostridium difficile testing. Open Forum Infect Dis 2019; 6:S805 [View Article]
    [Google Scholar]
  115. Sullivan EL, Majumdar R, Ortiz C, Riggs PK, Crum-Cianflone NF. The impact of changing reflexive to clinician-ordered Clostridioides difficile polymerase chain reaction (PCR) testing for indeterminate cases: cost savings without associated adverse events. Infect Control Hosp Epidemiol 2020; 41:684–690 [View Article] [PubMed]
    [Google Scholar]
  116. Tai DBG, Misra A, Sampathkumar P, O’Horo JC. Restricting ordering of multiplex gastrointestinal panel improves test utilization. Open Forum Infect Dis 2021; 8:S436–S437 [View Article]
    [Google Scholar]
  117. Tchou MJ, May S, Holcomb J, Tanner-Edwards E, Good K et al. Reducing point-of-care blood gas testing in the Intensive Care Unit through diagnostic stewardship: a value improvement project. Pediatr Qual Saf 2020; 5:e284 [View Article] [PubMed]
    [Google Scholar]
  118. Tirupathi R, Freshman R, Montoy N, Gross M. Diagnostic stewardship of C difficile PCR testing with two step algorithm- a rural community hospital experience. Open Forum Infect Dis 2020; 7:S437–S438 [View Article]
    [Google Scholar]
  119. Touzard-Romo F, Jackson G, Andrea S, Valerie W, Chargualaf T et al. Impact of Clostridium difficile (CD) Nucleic Acid Amplification Test (NAAT) approval on Hospital-Onset C. difficile Infection (HO-CDI): a diagnostic stewardship intervention. Open Forum Infect Dis 2021; 8:S477–S478 [View Article]
    [Google Scholar]
  120. Tran NN, Mills JP, Zimmerman C, Gandhi TN, Tribble AC et al. Incorporating preauthorization into antimicrobial stewardship pharmacist workflow reduces Clostridioides difficile and gastrointestinal panel testing. Infect Control Hosp Epidemiol 2020; 41:1136–1141 [View Article] [PubMed]
    [Google Scholar]
  121. Turner MC, Behrens SL, Webster W, Huslage K, Smith BA et al. Multidisciplinary approach to Clostridium difficile infection in Adult Surgical Patients. J Am Coll Surg 2019; 228:570–580 [View Article]
    [Google Scholar]
  122. van den Bergh D, Messina AP, Goff DA, van Jaarsveld A, Coetzee R et al. A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa. Int J Antimicrob Agents 2020; 56:106189 [View Article] [PubMed]
    [Google Scholar]
  123. Waagsbø B, Buset EM, Longva J-Å, Bjerke M, Bakkene B et al. Diagnostic stewardship aiming at expectorated or induced sputum promotes microbial diagnosis in community-acquired pneumonia. BMC Infect Dis 2022; 22:203 [View Article] [PubMed]
    [Google Scholar]
  124. Wadskier Montagne FG, Cowman K, Guo Y, Bartash R, Szymczak W et al. Report at your own risk! Diagnostic stewardship of Clostridioides difficile PCR results from syndromic diarrhea panel and implications for patient outcomes. Open Forum Infect Dis 2019; 6:S810–S811 [View Article] [PubMed]
    [Google Scholar]
  125. Walker SV, Steffens B, Sander D, Wetsch WA. Implementation of antibiotic stewardship improves the quality of blood culture diagnostics at an intensive care unit of a University Hospital. J Clin Med 2022; 11:3675 [View Article] [PubMed]
    [Google Scholar]
  126. Walter C, Soni T, Gavin MA, Kubes J, Paciullo K. An interprofessional approach to reducing hospital-onset Clostridioides difficile infections. Am J Infect Control 2022; 50:1346–1351 [View Article] [PubMed]
    [Google Scholar]
  127. Wang EW, Weekley A, McCarty J, Koo H, Lembcke B et al. Impact of a division-wide bundle on hospital-acquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs. Avicenna J Med 2021; 11:27–32 [View Article] [PubMed]
    [Google Scholar]
  128. Watson KJ, Trautner B, Russo H, Phe K, Lasco T et al. Using clinical decision support to improve urine culture diagnostic stewardship, antimicrobial stewardship, and financial cost: a multicenter experience. Infect Control Hosp Epidemiol 2020; 41:564–570 [View Article]
    [Google Scholar]
  129. Woods-Hill CZ, Colantuoni EA, Koontz DW, Voskertchian A, Xie A et al. Association of diagnostic stewardship for blood cultures in critically Ill children with culture rates, antibiotic use, and patient outcomes: results of the bright STAR collaborative. JAMA Pediatr 2022; 176:690–698 [View Article] [PubMed]
    [Google Scholar]
  130. Woods-Hill CZ, Lee L, Xie A, King AF, Voskertchian A et al. Dissemination of a novel framework to improve blood culture use in pediatric critical care. Pediatr Qual Saf 2018; 3:e112 [View Article] [PubMed]
    [Google Scholar]
  131. Woods-Hill C, Fackler J, Lee L, Smith M, Xie A et al. Multicenter optimization of blood cultures in critically ill children. Crit Care Med 2018; 46:637 [View Article]
    [Google Scholar]
  132. Wulff RT, Qiu Y, Wu C, Calfee DP, Singh HK et al. Laboratory interventions to eliminate unnecessary rapid COVID-19 testing during a reagent shortage. Am J Clin Pathol 2022; 158:401–408 [View Article] [PubMed]
    [Google Scholar]
  133. Zaver HB, Moktan VP, Harper EP, Bali A, Nasir A et al. Reduction in health care facility-onset Clostridioides difficile infection: a quality improvement initiative. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1066–1074 [View Article] [PubMed]
    [Google Scholar]
  134. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:71 [View Article]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001831
Loading
/content/journal/jmm/10.1099/jmm.0.001831
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error