Most institutions use rapid viral tests, but stewardship practices are uncommon
A survey investigating diagnostic and antimicrobial stewardship practices showed that most institutions used rapid respiratory panels. However, stewardship practices incorporating those tests were uncommon, researchers said.
“Although there is widespread implementation of molecular respiratory diagnostic testing, and there is literature that demonstrates its ability to assist in reducing unnecessary antibiotic use, how impactful these tools truly are and how they are being used by antimicrobial stewardship programs (ASPs) hasn’t been fully elucidated,” Kimberly C. Claeys, PharmD, assistant professor at the University of Maryland School of Pharmacy, told Healio. “We wanted to reach out to our colleagues across North America to ask them what their clinical microbiology laboratories and ASPs have done to best incorporate these tools into clinical practice to optimize antibiotic use.”
Claeys and colleagues developed a 32-item survey to explore diagnostic and ASP practices related to rapid molecular respiratory diagnostics. According to the study, the survey recorded demographic characteristics of institutions, their laboratory practices pertaining to specimen collection and respiratory viral testing, ASP practices and perceived impact on antibiotic use. Survey responses were collected between December 2019 and March 2020.
The survey was completed by 37 of 70 eligible members of the Society for Healthcare Epidemiology Research Network.
Among respondents, 13 (35.1%) were primarily involved in ASP activities, 13 (35.1%) in consultative infectious diseases services (n = 13; 35.1%) and 11 (29.8%) in infection prevention activities (n = 11; 29.8%).
According to the study, 94.5% of institutions (n = 35) reported using a respiratory viral panel (RVP) assay, but few reported the availability of an expanded pneumonia panel (n = 7; 18.9%), with the BioFire FilmArray RVP being the most commonly used (n = 25; 71.5%). Additionally, 60% of respondents (n = 21) reported that their institution had published guidance about when to order RVP testing, and 54% (n = 19) reported restrictions to limit inappropriate testing. Among these institutions, 10 (53%) indicated that restrictions were based on sample type and seven (37%) reported restrictions designed to reduce duplicate testing.
The researchers also learned more about the institutions’ ASP practices. According to the study, less than half of these institutions (n = 15; 42.9%) reported that they reviewed RVP results as part of routine ASP activities, whereas only five (14.3%) indicated that they perform real-time audit and feedback based on RVP results. Additionally, less than half of the institutions (n = 15; 42.9%) reported ASP-led educational activities related to appropriate interpretation of RVPs.
“Although this study was done prior to the COVID-19 pandemic, we saw that use of molecular respiratory diagnostic testing was common. This study really highlights, however, the need to better incorporate these tools into our ASPs and assess their impact on our ASP metrics locally,” Claeys said. “We have done an excellent job working with our clinical microbiology colleagues to optimize molecular diagnostics in bloodstream infections, but we still have work to do in other areas of diagnostic and antimicrobial stewardship.”