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Advances in Diagnostic Testing that Impact Infection Prevention and Antimicrobial Stewardship Programs

  • Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The primary purpose of this review is to provide a summary of new and emerging laboratory technologies and testing platforms that impact infection prevention and antimicrobial stewardship programs. This review also summarizes available data describing the clinical impact of implementing these new technologies.

Recent Findings

While there is ample evidence that rapid organism identification technologies for positive blood cultures can ameliorate antimicrobial utilization, an assay that also provides expedited antimicrobial susceptibility testing results is now available and its clinical impact is under investigation. For C. difficile infection diagnosis, data related to performance and impact of “ultrasensitive” toxin assays is emerging in the literature although their role in C. difficile infection diagnosis remains unclear. For hospital-acquired pneumonia, a variety of rapid, automated, multiplexed, “pneumonia” panels have become commercially available and may impact surveillance definitions for ventilator-associated events. Finally, recent FDA clearance of various biochemical and molecular carbapenemase detection tests will facilitate rapid characterization of carbapenem-resistant organisms.

Summary

Innovations in infectious diseases diagnostics have been making swift strides, broadening diagnostic scope; increasing accuracy and sensitivity; and reducing turnaround time. Many of these innovations directly impact infection prevention and antimicrobial stewardship operations. Close collaboration between infection control, antimicrobial stewardship, and the microbiology laboratory is necessary to ensure that new tests improve patient outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51–77.

    Article  PubMed  PubMed Central  Google Scholar 

  2. •• Buehler SS, Madison B, Snyder SR, Derzon JH, Cornish NE, Saubolle MA, et al. Effectiveness of practices to increase timeliness of providing targeted therapy for inpatients with bloodstream infections: a laboratory medicine best practices systematic review and meta-analysis. Clin Microbiol Rev. 2016;29:59–103. This reference is important because it is a comprehensive systematic review that examined clinical outcomes related to implementation of rapid blood culture diagnostics.

    Article  PubMed  Google Scholar 

  3. College of American Pathologists. 2018 DEX participant survey DEX-04, page 7.

  4. Diekema DJ. Rising stakes for health care-associated infection prevention: implications for the clinical microbiology laboratory. J Clin Microbiol. 2017;55:996–1001.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bloodstream infection event (central line-associated bloodstream infection and non-central line-associated bloodstream infection). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Accessed 3/14/2019.

  6. Gomez EJ, Montgomery S, Alby K, Robinson DP, Roundtree SS, Blecker-Shelly D, et al. Poor yield of Clostridium difficile testing algorithms using glutamate dehydrogenase antigen and C. difficile toxin enzyme immunoassays in a pediatric population with declining prevalence of clostridium difficile strain BI/NAP1/027. Diagn Microbiol Infect Dis. 2018;91:229–32.

    Article  CAS  PubMed  Google Scholar 

  7. Burnham CA, Carroll KC. Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev. 2013;26:604–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med. 2015;175:1792–801.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pollock NR. Ultrasensitive detection and quantification of toxins for optimized diagnosis of Clostridium difficile infection. J Clin Microbiol. 2016;54:259–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. National Health Service. Clostridium difficile: updated guidance on diagnosis and reporting. 2012. https://www.gov.uk/government/publications/updated-guidance-on-the-diagnosis-and-reporting-of-clostridium-difficile. Accessed 3/14/2019.

  11. Fang FC, Polage CR, Wilcox MH. Point-counterpoint: what is the optimal approach for detection of Clostridium difficile infection? J Clin Microbiol. 2015;55:670–80.

    Article  Google Scholar 

  12. Sandlund J, Bartolome A, Almazan A, Tam S, Biscocho S, Abusali S, et al. Ultrasensitive detection of Clostridioides difficile toxins a and B by use of automated single-molecule counting technology. J Clin Microbiol. 2018;56.

  13. •• Pollock NR, Banz A, Chen X, Williams D, Xu H, Cuddemi CA, et al. Comparison of Clostridioides difficile stool toxin concentrations in adults with symptomatic infection and asymptomatic carriage using an ultrasensitive quantitative immunoassay. Clin Infect Dis. 2019;68:78–86. This reference is important because it is the first study that investigated the clinical implications of ultrasensitive C. difficile toxin testing.

    PubMed  Google Scholar 

  14. Marra AR, Edmond MB, Ford BA, Herwaldt LA, Algwizani AR, Diekema DJ. Impact of 2018 Changes in National Healthcare Safety Network Surveillance for Clostridium difficile laboratory-identified event reporting. Infect Control Hosp Epidemiol. 2018(9):886–8.

    Article  Google Scholar 

  15. Sullivan KV. Rapid molecular panels: what is in the best interest of the patient? A review of patient outcome studies for multiplex panels used in bloodstream, respiratory, and neurological infections. Clin Microbiol Newsl. 2017;39:125–9.

    Article  Google Scholar 

  16. •• Vos LM, Bruning AHL, Reitsma JB, Schuurman R, Riezebos-Brilman A, Hoepelman AIM, Oosterheert JJ. Rapid molecular tests for influenza, respiratory syncytial virus, and other respiratory viruses: a systematic review of diagnostic accuracy and clinical impact studies. Clin Infect Dis. 2019. [E-publication] . This reference is important because it is a comprehensive systematic review that examined clinical outcomes related to implementation of rapid blood culture diagnostics.

  17. Infectious Disease Society of America. IDSA expresses concern over Palmetto GBA final LCD for multiplex nucleic acid amplified tests for respiratory viral panels. https://www.idsociety.org/news%2D%2Dpublications-new/articles/2018/idsa-expresses-concern-over-palmetto-gba-final-lcd-for-multiplex-nucleic-acid-amplified-tests-for-respiratory-viral-panels. Accessed 3/14/2019.

  18. Ventilator-associated and non-ventilator-associated Pneumonia. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf.

  19. US Food and Drug Administration. https://www.accessdata.fda.gov/cdrh_docs/pdf18/K181324.pdf Accessed 3/14/2019.

  20. US Food and Drug Administration. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/denovo.cfm?ID=DEN170047 Accessed 3/14/2019.

  21. Lutgring JD, Limbago BM. The problem of carbapenemase-producing carbapenem-resistant Enterobacteriaceae detection. J Clin Microbiol. 2016;54:529–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Centers for Disease Control and Prevention. Tracking CRE. https://www.cdc.gov/hai/organisms/cre/trackingcre.html. Accessed 3/14/2019.

  23. Castanheira M, Mills JC, Costello SE, Jones RN, Sader HS. Ceftazidime-avibactam activity tested against Enterobacteriaceae isolates from U.S. hospitals (2011–2013) and characterization of β-lactamase producing strains. Antimicrob Agents Chemother. 2015;59:3509–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Hackel MA, Lomovskaya O, Dudley MN, Karlowsky JA, Sahm DF. In vitro activity of meropenem-vaborbactam against clinical isolates of KPC-positive Enterobacteriaceae. Antimicrob Agents Chemother. 2017;62:e01904–17.

    PubMed  PubMed Central  Google Scholar 

  25. Pogue JM, Bonomo RA, Kaye KS. Ceftazidime/avibactam, Meropenem/Vaborbactam, or both? clinical and formulary considerations. Clin Infect Dis. 2019;68:519–24.

    Article  PubMed  Google Scholar 

  26. CLSI. Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. In: CLSI document M100-S29. Wayne, PA: Clinical and Laboratory Standards Institute; 2019.

    Google Scholar 

  27. • Tamma PD, Opene BN, Gluck A, Chambers KK, Carroll KC, Simner PJ. Comparison of 11 phenotypic assays for accurate detection of carbapenemase-producing enterobacteriaceae. J Clin Microbiol. 2017;55:1046–55. This reference is important because it is a comprehensive examination of existing methods of detecting carbapenemase production.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Temple University Health System, Temple University Hospital, Lewis Katz School of Medicine at Temple University, 3401 N. Broad St., Room A2 F329, Philadelphia, PA, 19140, USA

    Kaede V. Sullivan

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Correspondence to Kaede V. Sullivan.

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Kaede V. Sullivan declares no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Healthcare Associated Infections

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Sullivan, K.V. Advances in Diagnostic Testing that Impact Infection Prevention and Antimicrobial Stewardship Programs. Curr Infect Dis Rep 21, 20 (2019). https://doi.org/10.1007/s11908-019-0676-7

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  • DOI: https://doi.org/10.1007/s11908-019-0676-7

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