Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul;13(7):1621-1637.
doi: 10.1007/s40121-024-00996-1. Epub 2024 Jun 3.

Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals

Timothy Jinks  1 , Sumithra Subramaniam  2 , Matteo Bassetti  3 , Ana C Gales  4 , Ravina Kullar  5 , Mark L Metersky  6 , Aruna Poojary  7 , Harald Seifert  8   9   10 , Anup Warrier  11 , Diane Flayhart  12 , Timothy Kelly  12 , Kalvin Yu  12 , Bruce M Altevogt  13 , Andy Townsend  14 , Charlotte Marsh  15 , Clare Willis  15
Affiliations

Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals

Timothy Jinks et al. Infect Dis Ther. 2024 Jul.

Abstract

Introduction: Antimicrobial resistance (AMR) is a global public health challenge. Global efforts to decrease AMR through antimicrobial stewardship (AMS) initiatives include education and optimising the use of diagnostic technologies and antibiotics. Despite this, economic and societal challenges hinder AMS efforts. The objective of this study was to obtain insights from healthcare professionals (HCPs) on current challenges and identify opportunities for optimising diagnostic test utilisation and AMS efforts.

Methods: Three hundred HCPs from six countries (representing varied gross national incomes per capita, healthcare system structure, and AMR rates) were surveyed between November 2022 through January 2023. A targeted literature review and expert interviews were conducted to inform survey development. Descriptive statistics were used to summarise survey responses.

Results: These findings suggest that the greatest challenges to diagnostic test utilisation were economic in nature; many HCPs reported that AMS initiatives were lacking investment (32.3%) and resourcing (40.3%). High resistance rates were considered the greatest barriers to appropriate antimicrobial use (52.0%). Most HCPs found local and national guidelines to be very useful (≥ 51.0%), but areas for improvement were noted. The importance of AMS initiatives was confirmed; diagnostic practices were acknowledged to have a positive impact on decreasing AMR (70.3%) and improving patient outcomes (81.0%).

Conclusion: AMS initiatives, including diagnostic technology utilisation, are pivotal to decreasing AMR rates. Interpretation of these survey results suggests that while HCPs consider diagnostic practices to be important in AMS efforts, several barriers to successful implementation still exist including patient/institutional costs, turnaround time of test results, resourcing, AMR burden, and education. While some barriers differ by country, these survey results highlight areas of opportunities in all countries for improved use of diagnostic technologies and broader AMS efforts, as perceived by HCPs. Greater investment, resourcing, education, and updated guidelines offer opportunities to further strengthen global AMS efforts.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Bacteria and bacterial infections; Diagnostic technologies; Healthcare professional survey.

Plain language summary

Antimicrobials are medications used to treat infections caused by bacteria (e.g. antibiotics), viruses, parasites, and fungi. Over time, these microbes may become resistant to antimicrobials, limiting how well they work. This often happens as a result of overuse, using antimicrobials when there is not an infection, or using an inappropriate antimicrobial. Antimicrobial resistance is a growing global problem. Antimicrobial stewardship programs aim to improve appropriate use of antimicrobials. Diagnostic testing plays an important role in these programs by identifying the microbes responsible for infections so patients can be given the right treatment as quickly as possible. We aimed to obtain the perspective of healthcare professionals from six countries on the challenges of and ways to improve diagnostic testing and antimicrobial stewardship programs. We found that some of the greatest challenges were related to costs. Approximately one-third of participants said that antimicrobial stewardship initiatives were lacking investment (32.3%) and resourcing (40.3%). High rates of antimicrobial resistance were identified as the greatest barriers to appropriate antimicrobial use (52.0%). Participants said that diagnostic practices have a positive impact on decreasing antimicrobial resistance (70.3%) and improving patient outcomes (81.0%). Overall, we found that healthcare professionals consider diagnostic tests to be an important part of antimicrobial stewardship, but there are several barriers to their success, including patient/hospital costs, turnaround time of test results, resourcing, antimicrobial resistance, and education. To overcome these barriers, increased funding, education, and resourcing, regular guideline updates, and development of optimised testing algorithms may help to improve antimicrobial stewardship and ultimately decrease antimicrobial resistance.

PubMed Disclaimer

Conflict of interest statement

The work on this manuscript was funded by a consortium of partner organisations including Becton, Dickinson and Co (Diane Flayhart, Timothy Kelly, and Kalvin Yu), Pfizer Inc (Bruce M. Altevogt and Andy Townsend), The Wellcome Trust (Timothy Jinks and Sumithra Subramaniam), bioMérieux SA., and the AMR Industry Alliance (AMRIA). Timothy Jinks and Sumithra Subramaniam disclose they are employees of The Wellcome Trust. Diane Flayhart, Timothy Kelly, and Kalvin Yu disclose they are employees and shareholders of Becton, Dickinson and Co. Andy Townsend discloses that they are an employee and shareholder of Pfizer Inc. Bruce M. Altevogt’s current affiliation is bioMérieux. Bruce M. Altevogt was an employee of Pfizer Inc. during the planning and start of the study and he is currently a shareholder of Pfizer Inc. Clare Willis, Jacqueline Michel, and Kristen Downs disclose they are employees of Genesis Research, a company that received funding for its role in conducting the study and developing the manuscript. Charlotte Marsh was an employee of Genesis Research at the time of the study. Charlotte Marsh’s current affiliation is RJW & partners Ltd. Harald Seifert, Aruna Poojary, Ana C. Gales, Mark L. Metersky, Ravina Kullar, Matteo Bassetti, and Anup Warrier disclose that they received consultancy fees in relation to this project. Ana C. Gales discloses that she has received grants or contracts from Eurofarma within the last 36 months. Harald Seifert, Ana C. Gales, and Matteo Bassetti disclose that they have received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events within the last 36 months. Bruce M. Altevogt, Kalvin Yu, and Timothy Jinks discloses their leadership or fiduciary role in other board, society, committee, or advocacy group. Ana C. Gales and Timothy Jinks discloses that they have received support for attending meetings and/or travel within the last 36 months. Matteo Bassetti discloses that he has participated on a data safety monitoring board or advisory board within the last 36 months. Matteo Bassetti is an Editorial Board member of Infectious Diseases and Therapy. Matteo Bassetti was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions.

Figures

Fig. 1
Fig. 1
Reported impact of current diagnostic testing landscape/practices on patient, economic and AMS outcomes. Participants were asked to select the most appropriate option for each outcome listed on the basis on the current diagnostic testing landscape/practices in your hospital. AMR antimicrobial resistance, AMS antimicrobial stewardship. n = 300 per outcome
Fig. 2
Fig. 2
Most commonly reported challenges to the use of diagnostic tests across the treatment pathway. AMR antimicrobial resistance, AMS antimicrobial stewardship, HCP healthcare professional. n = 50 respondents per country. Respondents could select up to five answers
Fig. 3
Fig. 3
Most commonly reported challenges to the use of narrow-spectrum antibiotics. AMR antimicrobial resistance, AMS antimicrobial stewardship, AST antimicrobial susceptibility testing, HCP healthcare professional, ID infectious diseases, MDROs multidrug resistant organisms. n = 50 respondents per country. Respondents could select up to five answers
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55. 10.1016/s0140-6736(21)02724-0. - PMC - PubMed
    1. O'Neill J. Tackling drug-resistant infections globally: final report and recommendations. Government of the United Kingdom; 2016. https://apo.org.au/node/63983. Accessed 28 May 2024.
    1. World Health Organization. Global antimicrobial resistance and use surviellance system (GLASS) report. 2022. https://iris.who.int/bitstream/handle/10665/364996/9789240062702-eng.pdf.... Accessed 28 May 2024.
    1. Sriram A, Kalanxhi E, Kapoor G, et al. In: Atwater S, editor. The state of the world's antibiotics 2021: a global analysis of antimicrobial resistance and its drivers. Washington, DC: Center for Disease Dynamics, Economics & Policy; 2021.
    1. World Health Organization. Global action plan on antimicrobial resistance. 2015. https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf.... Accessed 28 May 2024. - PubMed

LinkOut - more resources