Diagnostic Stewardship

Unnötige diagnostische Tests erzeugen Resultate, die dann zu unnötigen weiteren Tests zur Abklärung, zur Verunsicherung von Patienten und Behandlern oder z.B. bei mikrobiologischen Untersuchungen zu nicht erforderlichen Antibiotikagaben führen können. In jüngster Zeit rückt die rechtfertigende Indikation zur Durchführung einer mikrobiologischen Diagnostik daher zunehmend in den Fokus von Antibiotic Stewardship (ASB)-Programmen.

Abstract

In 2023, the Society for Healthcare Epidemiology of America (SHEA) Task Force issued a practice recommendation on the integration of diagnostic stewardship into antibiotic stewardship (ABS) programs, which focuses on optimizing sample collection, processing, and reporting to ensure a correct test result on the one hand, and on the justifying indication to perform diagnostics on the other.

Unnecessary microbiological or serological tests produce results that can then lead to unnecessary further tests for clarification or unnecessary antibiotic administration. A classic example is "routine" urine cultures before non-urological, surgical interventions, which often lead to the treatment of asymptomatic bacteriuria. Every microbiological diagnosis must therefore be preceded by a specific question, whereby screening examinations from epidemiological questions must be clearly distinguished from clinical requirements. A particular problem is the distinction between contamination, colonization and infection, especially when samples are taken from catheters or drains. These materials should always be evaluated with extreme caution and may only be accepted at all if the clinical question is clear and subject to this very reservation. This article summarizes the existing evidence on diagnostic stewardship interventions and recommendations on their implementation, extrapolating the international literature to the specifications of the German health care system.

Kernaussagen

• In der Literatur findet Diagnostic Stewardship zunehmend im Kontext mit Antibiotic Stewardship Erwähnung.

• Diagnostic Stewardship soll die Patientensicherheit und das Outcome verbessern.

• Hierzu sollen unnötige Belastungen der Patienten durch nicht indizierte Testverfahren vermieden und der Gebrauch von Antibiotika optimiert werden.

• Durch geeignete Qualitätsindikatoren kann der Erfolg von Diagnostic-Stewardship-Interventionen gemessen und das Feedback gleichzeitig als Werkzeug zur Verhaltensänderung bzw. Verhaltensverstärkung genutzt werden.

• Diagnostic Stewardship dient auch der optimierten Ressourcennutzung und kann dadurch Kosten reduzieren und den ökologischen Fußabdruck einer medizinischen Einrichtung verbessern.

Schlüsselwörter

Antiinfektiva - Testverfahren - Antibiogramm - Infektiologie

Keywords

Diagnostic stewardship - antibiotic stewardship - microbiological tests - diagnostic sensitivity and specificity

Publication History

Article published online:
19 September 2023

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