Beganovic Maya, McCreary Erin K, Mahoney Monica V, Dionne Brandon, Green Daniel A, Timbrook Tristan T
Advocate Lutheran General Hospital, Department of Pharmacy, Park Ridge, IL.
University of Pittsburgh Medical Center, Department of Pharmacy, Pittsburgh, PA.
J Appl Lab Med. 2019 Jan;3(4):601-616. doi: 10.1373/jalm.2018.026450. Epub 2018 Nov 20.
Antimicrobial stewardship programs (ASPs) aim to provide optimal antimicrobial therapy to patients quickly to improve the likelihood of overcoming infection while reducing the risk of adverse effects. Rapid diagnostic tests (RDTs) for infectious diseases have become an integral tool for ASPs to achieve these aims.
This review explored the demonstrated clinical value of longer-standing technologies and implications of newer RDTs from an antimicrobial stewardship perspective. Based on available literature, the focus was on the use of RDTs in bloodstream infections (BSIs), particularly those that perform organism identification and genotypic resistance detection, phenotypic susceptibility testing, and direct specimen testing. Clinical implications of rapid testing among respiratory, central nervous system, and gastrointestinal infections are also reviewed.
Coupling RDTs with ASPs facilitates the appropriate and timely use of test results, translating into improved patient outcomes through optimization of antimicrobial use. These benefits are best demonstrated in the use of RDT in BSIs. Rapid phenotypic susceptibility testing offers the potential for early pharmacokinetic/pharmacodynamic optimization, and direct specimen testing on blood may allow ASPs to initiate appropriate therapy and/or tailor empiric therapy even sooner than other RDTs. RDTs for respiratory, central nervous system, and gastrointestinal illnesses have also shown significant promise, although more outcome studies are needed to evaluate their full impact.
抗菌药物管理计划（ASPs）旨在迅速为患者提供最佳抗菌治疗，以提高战胜感染的可能性，同时降低不良反应风险。传染病快速诊断检测（RDTs）已成为ASPs实现这些目标的重要工具。
本综述从抗菌药物管理的角度探讨了长期存在的技术已证实的临床价值以及新型RDTs的意义。基于现有文献，重点关注RDTs在血流感染（BSIs）中的应用，特别是那些进行病原体鉴定和基因型耐药性检测、表型药敏试验以及直接标本检测的技术。还综述了快速检测在呼吸道、中枢神经系统和胃肠道感染中的临床意义。
将RDTs与ASPs相结合有助于合理、及时地使用检测结果，通过优化抗菌药物使用改善患者预后。这些益处最明显地体现在RDTs在BSIs中的应用。快速表型药敏试验为早期药代动力学/药效学优化提供了可能，对血液进行直接标本检测可能使ASPs比其他RDTs更早地开始适当治疗和/或调整经验性治疗。用于呼吸道、中枢神经系统和胃肠道疾病的RDTs也显示出巨大潜力，不过还需要更多结局研究来评估其全面影响。
