eHealth and mHealth in Antimicrobial Stewardship Programs

Abstract

Background: The global need for rapid diagnostic methods for pathogen identification and antimicrobial susceptibility testing (AST) is underscored by the increasing bacterial resistance and limited therapeutic options, especially critical in sepsis management.

Summary: This review examines the aspects of the eHealth and mHealth in Antimicrobial Stewardship Programs (ASPs) to improve the treatment of infections and rational use of antimicrobials.

Key messages: The evolution from traditional phenotype-based methods to rapid molecular and mass spectrometry techniques has significantly decreased result turnaround times, improving patient outcomes. Despite advancements, the complex decision-making in antimicrobial therapy often exceeds the capacity of many clinicians, highlighting the importance of ASPs. These programs, integrating mHealth and eHealth, leverage technology to enhance healthcare services and patient outcomes, particularly in remote or resource-limited settings. However, the application of such technologies in antimicrobial management remains underexplored in hospitals. The development of platforms combining antimicrobial prescription data with pharmacotherapeutic algorithms and laboratory integration can significantly reduce costs and improve hospitalization times and mortality rates.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Pharmacotherapeutic algorithms; Rapid diagnostic methods; mHealth and eHealth.

Fig. 1.

Flow of clinical sample processing in the microbiology laboratory and approximate time for results. The arrows indicate potential test flows such as direct molecular examination of clinical samples or after growth on culture media. MALDI-TOF, matrix-assisted laser desorption ionization time-of-flight; AST, antimicrobial susceptibility test; ID, identification.

Fig. 2.

Algorithm for developing a platform with retrospective clinical and microbiological data to generate appropriate empirical treatment, incorporating current patient clinical data and combining it with microbiological results for tele-stewardship application.

Fig. 3.

Screen of the tele-stewardship program used for pharmacotherapy interventions.

Fig. 4.

Impact of the approach type and its impacts on mortality, direct and indirect costs, and length of stay. The three approaches include the use of molecular tests in the initial stage of etiological diagnosis, using classic microbiology and a platform to assist in faster results and interaction with the care team, and the last is the approach of empirical use without intensive action from antimicrobial stewardship.

Fig. 5.

Potential impact of the MICLAB (tele-stewardship) integrating the laboratory (diagnostic stewardship).

Fig. 6.

Demonstrations of some impacts of tele-stewardship with rapid interaction in the laboratory on length of hospital stay, multiresistant bacteria (CRE, carbapenem-resistant enterobacteriales), cost with antimicrobial surgical prophylaxis, and antibiotic consumption.

Fig. 7.

Breakeven curve in a relationship between the cost of correctly administering empirical antibiotic therapy (blue line) compared to the cost of molecular testing on all clinical samples, including the costs of team and tele-stewardship software (red line).