Division of Infectious Diseases, Department of Internal Medicine, University of Utah.
Veteran's Affairs Salt Lake City Healthcare System.
Curr Opin Infect Dis. 2024 Dec 1;37(6):565-572. doi: 10.1097/QCO.0000000000001057. Epub 2024 Jul 31.
We aim to review the rationale, methods, and experiences with diagnostic stewardship targeted at urinary tract infection (UTI) and related urinary syndromes.
In the last 18 months, several articles have demonstrated the impact of diagnostic stewardship interventions at limiting inappropriate diagnosis of UTIs or inappropriate antibiotic-prescribing, targeting the urinary tract. Antimicrobial stewardship programs may create and implement interventions at the point of urine test ordering, urine test resulting, or at the point of prescribing antibiotics after results have returned. Specific design and implementation of stewardship interventions depends on context. To maximize their impact, interventions should be accompanied by education and garner buy-in from providers.
Diagnostic stewardship can decrease unnecessary antibiotics and inappropriate diagnosis of UTI with multifaceted interventions most likely to be effective. Remaining questions include how to reduce ASB treatment in new populations, such as those with immune compromise, and persistent unknowns regarding UTI diagnosis and diagnostics.
本综述旨在回顾针对尿路感染（UTI）和相关尿路综合征的诊断管理的基本原理、方法和经验。
在过去的 18 个月中，有几篇文章已经证明了诊断管理干预在限制对 UTI 的不适当诊断或对尿路的不适当抗生素处方的影响。抗菌药物管理计划可以在尿液检测申请、尿液检测结果或抗生素开出处方时制定和实施干预措施。管理干预措施的具体设计和实施取决于具体情况。为了最大限度地发挥其影响，干预措施应辅以教育，并获得提供者的认可。
通过多方面的干预措施，诊断管理可以减少不必要的抗生素和不适当的 UTI 诊断。最有可能有效的干预措施。仍存在一些问题，例如如何减少免疫功能低下等新人群的无症状性菌尿治疗，以及关于 UTI 诊断和诊断方法的未知问题。
