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Antimicrobial Stewardship and Rapid Diagnostic Testing: The role of the pharmacist in optimizing data and technology

By accelerating the rate at which organisms and their susceptibility to antimicrobial drugs are identified, RDTs speed diagnoses and corresponding treatments. While these tests have associated costs, they are proving to be cost effective tools for many antimicrobial stewardship programs.

The collective strategies that represent antimicrobial stewardship are paramount to getting ahead of the antimicrobial resistance challenge—a growing epidemic that is responsible for an average of 23,000 mortalities annually and a financial toll of nearly $34 billion in the U.S. alone. Prior to RDTs, antimicrobial susceptibility test results took several days to reach clinical decision makers. Advances in these tests, such as the matrix-assisted laser desorption ionization, improve the outlook by reducing that time to several hours.

To facilitate effective processes and outcomes, collaboration between both lab and pharmacy staff members is vital. Lab staff must utilize RDTs and instruct providers to accurately interpret the data received from the tests, while pharmacists must also be trained to comprehend test results and rapidly respond with appropriate therapeutic recommendations.

Effective Administration

Proper utilization of RDTs speed treatment response when workflows are aligned with proactive application of results. Labs must be accountable to identify organisms and immediately alert clinicians to ensure appropriate administration of therapies. This reduces the likelihood that inappropriate drugs will be used. Collaboration between the microbiologist and the antimicrobial stewardship pharmacist is advantageous in developing enhanced communication among disciplines to support a more holistic approach to patient care.  

Outcomes are shown to improve when RDT results are used with clinical decision support (CDS) systems that speed the response of those lab results. Antimicrobial stewardship pharmacists can then take the role of an intermediary, responsible for acting on this data to ensure proper care and timely decisions. Real-time CDS surveillance solutions, such as Sentri7, aid in the multidisciplinary efforts required to improve timely, appropriate antimicrobial administration. Clinical rules in Sentri7 can target RDT results, evaluate the results, immediately alert clinicians as to the RDT findings and make treatment recommendations based on local antibiogram data.  Frankly, RDTs are only valuable if the information actually gets to the right clinician in a timely manner and CDS systems ensure this occurs. . Pharmacists can utilize RDTs to accurately identify organisms and antimicrobial susceptibility, as well as leverage the ability of CDS systems to enhance antimicrobial stewardship programs and improve patient outcomes.

Cost-Effective Implementation

In a recent study, RDTs and antimicrobial stewardship initiatives were implemented to improve antibiotic therapy and reduce mortality rates. A CDS system was also utilized to alert providers of critical values in real-time at the point of care. The stewardship team was tasked with overseeing the process and providing evidence-based recommendations to prescribers. The initiative significantly reduced inpatient mortalities and length of stays, as well as saved the hospital an estimated $2.4 million in expenditures.

RDTs can greatly benefit facilities with limited resources, such as community hospitals, that lack antimicrobial stewardship or infectious disease-trained pharmacists or proper equipment and systems for complex lab tests. Despite this, RDTs can be costly and organizations need to determine the most clinically- and cost-effective strategies for implementation. Antimicrobial stewardship pharmacists can provide important oversight in the use of RDTs and the rapid distribution of results, leading to improved antimicrobial therapy and patient outcomes.

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