Diagnostic Stewardship in Antimicrobial Stewardship

On a global scale, infec/ons are a leading contributor to morbidity and mortality. Use of diagnos/c tests for pa/ents with suspected infec/ons are known to improve pa/ent care. Hence, there has been an increasing use of acute phase reactants (APRs) to guide treatment of infec/ons since the presence of these markers signify injury and inflamma/on.1 According to Zakhour et al there has been an overuse of diagnos/c tests, par/cularly in pa/ents who are cri/cally ill or immunocompromised.2 The overuse of tests applies even to mild infec/ons where unnecessary tes/ng lead to inappropriate treatment for colonizers iden/fied through culture. Diagnos/c stewardship plays a key role to help physicians request the right tests for the right pa/ent at the right /me. This involves providing coordinated guidance and interven/ons to ensure that tests especially cultures, are used appropriately and promptly to produce clinically relevant results. This guides medical decisions, while also conserving healthcare resources. Diagnos/c stewardship therefore serves as a complement to An/microbial Stewardship (AMS).3 The objec/ve of this review is to look into Diagnos/c Stewardship as a component of An/microbial Stewardship. The discussion will focus on the use of inflammatory markers including erythrocyte sedimenta/on rate (ESR), C-Reac/ve Protein (CRP), and procalcitonin. The role of blood culture and a PCR based pneumonia panel in will also be examined.