Microbiology and Laboratory Diagnostics
Î We suggest development of stratified antibiograms over solely
relying on nonstratified antibiograms to assist ASPs in developing
guidelines for empiric therapy (W-L).
• Stratification can expose important differences in susceptibility, which can
help ASPs develop optimized treatment recommendations and guidelines.
Î We suggest selective and cascade reporting of antibiotics over
reporting of all tested antibiotics (W-L).
• Some form of selective or cascaded reporting is reasonable. After
implementation, ASPs should review prescribing to ensure there are no
unintended consequences.
Î We suggest the use of rapid viral testing for respiratory pathogens to
reduce the use of inappropriate antibiotics (W-L).
Î We suggest rapid diagnostic testing in addition to conventional
culture and routine reporting on blood specimens if combined with
active ASP support and interpretation (W-M).
Î In adults in ICUs with suspected infection, we suggest the use
of serial procalcitonin measurements as an ASP intervention to
decrease antibiotic use (W-M).
Î In patients with hematologic malignancy at risk of contracting
invasive fungal disease, we suggest incorporating nonculture-based
fungal markers in ASP interventions to optimize antifungal use (W-L).
Measurement
Î We suggest monitoring antibiotic use as measured by days of therapy
(DOT) in preference to defined daily dose (DDD) (W-L).
• Every ASP must measure antibiotic use, stratified by antibiotic. DOTs are
preferred, but DDDs remain an alternative for sites that cannot obtain patient-
level antibiotic use data. ASPs should consider measurement of appropriate
antibiotic use within their own institutions by examining compliance with local or
national guidelines, particularly when assessing results of a targeted intervention,
and share that data with clinicians to help inform their practice. Although rates of
CDI or antibiotic resistance may not reflect ASP impact, those outcomes may also
be used for measurement of targeted interventions.
Î We recommend measuring antibiotic costs based on prescriptions or
administrations instead of purchasing data (GPR).
Î Measures that consider the goals and size of the syndrome-specific
intervention should be used (See Table 2) (GPR).
