Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals

• Published in: Infectious diseases and therapy Vol. 13; no. 7; pp. 1621 - 1637
• Main Authors: Jinks, Timothy, Subramaniam, Sumithra, Bassetti, Matteo, Gales, Ana C., Kullar, Ravina, Metersky, Mark L., Poojary, Aruna, Seifert, Harald, Warrier, Anup, Flayhart, Diane, Kelly, Timothy, Yu, Kalvin, Altevogt, Bruce M., Townsend, Andy, Marsh, Charlotte, Willis, Clare
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-07-2024; Springer; Springer Nature B.V; Adis, Springer Healthcare
• Subjects: Antibiotics; Antimicrobial agents; Antimicrobial resistance; Antimicrobial stewardship; Bacteria and bacterial infections; Clinical outcomes; Diagnostic technologies; Diagnostic tests; Drug resistance; Education; Health care; Healthcare professional survey; Hospital costs; Infectious Diseases; Internal Medicine; Literature reviews; Medical colleges; Medical diagnosis; Medical equipment and supplies industry; Medical personnel; Medical test kit industry; Medical tests; Medicine; Medicine & Public Health; Original Research; Parasites; Pharmaceutical industry; Polls & surveys; Public health; Surveys; Brazil; United States; China; Germany; India; Antimicrobial stewardship; Bacteria and bacterial infections; Antimicrobial resistance; Healthcare professional survey; Diagnostic technologies
• ISSN: 2193-8229; 2193-6382
• DOI: 10.1007/s40121-024-00996-1

Introduction
Antimicrobial resistance (AMR) is a global public health challenge. Global efforts to decrease AMR through antimicrobial stewardship (AMS) initiatives include education and optimising the use of diagnostic technologies and antibiotics. Despite this, economic and societal challenges hinder AMS efforts. The objective of this study was to obtain insights from healthcare professionals (HCPs) on current challenges and identify opportunities for optimising diagnostic test utilisation and AMS efforts.
Methods
Three hundred HCPs from six countries (representing varied gross national incomes per capita, healthcare system structure, and AMR rates) were surveyed between November 2022 through January 2023. A targeted literature review and expert interviews were conducted to inform survey development. Descriptive statistics were used to summarise survey responses.
Results
These findings suggest that the greatest challenges to diagnostic test utilisation were economic in nature; many HCPs reported that AMS initiatives were lacking investment (32.3%) and resourcing (40.3%). High resistance rates were considered the greatest barriers to appropriate antimicrobial use (52.0%). Most HCPs found local and national guidelines to be very useful (≥ 51.0%), but areas for improvement were noted. The importance of AMS initiatives was confirmed; diagnostic practices were acknowledged to have a positive impact on decreasing AMR (70.3%) and improving patient outcomes (81.0%).
Conclusion
AMS initiatives, including diagnostic technology utilisation, are pivotal to decreasing AMR rates. Interpretation of these survey results suggests that while HCPs consider diagnostic practices to be important in AMS efforts, several barriers to successful implementation still exist including patient/institutional costs, turnaround time of test results, resourcing, AMR burden, and education. While some barriers differ by country, these survey results highlight areas of opportunities in all countries for improved use of diagnostic technologies and broader AMS efforts, as perceived by HCPs. Greater investment, resourcing, education, and updated guidelines offer opportunities to further strengthen global AMS efforts.
Plain Language Summary
Antimicrobials are medications used to treat infections caused by bacteria (e.g. antibiotics), viruses, parasites, and fungi. Over time, these microbes may become resistant to antimicrobials, limiting how well they work. This often happens as a result of overuse, using antimicrobials when there is not an infection, or using an inappropriate antimicrobial. Antimicrobial resistance is a growing global problem. Antimicrobial stewardship programs aim to improve appropriate use of antimicrobials. Diagnostic testing plays an important role in these programs by identifying the microbes responsible for infections so patients can be given the right treatment as quickly as possible. We aimed to obtain the perspective of healthcare professionals from six countries on the challenges of and ways to improve diagnostic testing and antimicrobial stewardship programs. We found that some of the greatest challenges were related to costs. Approximately one-third of participants said that antimicrobial stewardship initiatives were lacking investment (32.3%) and resourcing (40.3%). High rates of antimicrobial resistance were identified as the greatest barriers to appropriate antimicrobial use (52.0%). Participants said that diagnostic practices have a positive impact on decreasing antimicrobial resistance (70.3%) and improving patient outcomes (81.0%). Overall, we found that healthcare professionals consider diagnostic tests to be an important part of antimicrobial stewardship, but there are several barriers to their success, including patient/hospital costs, turnaround time of test results, resourcing, antimicrobial resistance, and education. To overcome these barriers, increased funding, education, and resourcing, regular guideline updates, and development of optimised testing algorithms may help to improve antimicrobial stewardship and ultimately decrease antimicrobial resistance.