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. 2021 Jun 29;10(1):95.
doi: 10.1186/s13756-021-00961-4.

Intensivists' beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study

Alyssa M Pandolfo  1 , Robert Horne  2 , Yogini Jani  3 , Tom W Reader  4 , Natalie Bidad  1 , David Brealey  5 , Virve I Enne  6 , David M Livermore  7 , Vanya Gant  8 , Stephen J Brett  9 ; INHALE WP2 Study Group
Collaborators, Affiliations

Intensivists' beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study

Alyssa M Pandolfo et al. Antimicrob Resist Infect Control. .

Abstract

Background: Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians' endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians' beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care.

Methods: We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians' beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically.

Results: Clinicians' beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians' prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device's capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results.

Conclusions: Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests' capabilities and integration into clinical practice. Implementation strategies should bolster users' necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests' purpose and benefits, identifying and addressing clinicians' misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60-90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.

Keywords: Antimicrobial prescription; Intensive care; Rapid molecular diagnostics.

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Conflict of interest statement

DB reports personal fees (lecture fees) from bioMerieux, outside the submitted work. VIE reports personal fees and non-financial support from bioMerieux, personal fees from Curetis GmbH, and non-financial support from Oxford Nanopore Technologies, outside the submitted work. DML reports personal fees from Accelerate, Allecra, Antabio, Astellas, Beckman Coulter, bioMerieux, Cepheid, Centauri, Entasis, Johnson & Johnson, Meiji, Melinta, Menarini, Mutabilis, Nordic, ParaPharm, QPEX, Roche, Shionogi, Tetraphase, Wockhardt, 471 Zambon, Cardiome, and Eumedica. He also reports grants and personal fees from VenatoRx; personal fees and other (shareholder) from GlaxoSmithKline; personal fees and other (stock options) from T.A.Z.; grants, personal fees, and other (shareholder) from Merck/MSD and Pfizer; other (shareholder) from Perkin Elmer and Dechra. He also has nominated holdings in Avacta, Byotrol, Destiny, Diaceutics, Evgen, Faron, Fusion Antibodies, Genedrive, Hardide, Renalytics, Scancell and Synairgen (all of which have research/products pertinent to medical and diagnostic innovation) through Enterprise Investment Schemes, but has no authority to trade these shares directly. All are outside the submitted work. VG reports receiving speaking honoraria from bioMerieux and support for conference attendances from Merck/MSD and Gilead, outside the submitted work. Other authors have no potential conflicts of interest.

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