The power of a prompt, precise diagnosis in shaping the appropriate management of infection is widely recognised, but the key challenge is the appropriate integration into clinical care pathways and decision making, in both urgent and routine settings.

 

Diagnostic stewardship

 

This process of optimisation is known as diagnostic stewardship. This includes appropriate, timely diagnostic testing, including specimen collection, and pathogen identification and accurate, timely reporting of results to guide the treatment of suitable patients. Delivering effective diagnostic stewardship in healthcare settings will require a multiprofessional approach that brings together clinical staff, laboratory staff and epidemiological experts.

Bringing together partners from the NHS, academia, industry and other national bodies, to develop coordinated, professional guidance and evaluation of appropriate interventions.

To ensure effective adoption and implementation of diagnostic stewardship, the UK is adopting a coordinated national approach through the formation of the UK Antimicrobial Resistance (AMR) Diagnostic Collaborative. This brings together partners from across the NHS, academia, industry and other national bodies to develop coordinated professional guidance and evaluation of appropriate interventions to ensure proper integration of high-quality diagnostics service across the full range of care pathways. While early work to build this collaborative is taking place, the UK AMR DC will be formally launched on 5th July 2018.

The combined expertise of the UK AMR DC will play a central role in the evaluation of evolving technologies and approaches. Novel diagnostics are emerging, such as rapid point-of-care tests or genomic technologies that have the potential to transform appropriate treatment decisions. We need to ensure that the promise of these devices meets high expectations. Effective evaluation will require a coordinated approach across the innovation pipeline–from invention through evaluation and adoption–to gain the maximum impact on the AMR challenge.

 

Changing established approaches

 

Alongside this, there will need to be a structured approach to education, training and upskilling for the range of staff involved in the clinical and diagnostic pathways. Changing established approaches and care pathways is always one of the greatest challenges in healthcare settings and can often be the ‘make or break’ in whether a novel device or technology will deliver in the real world. Identifying and developing the appropriate education should be a key part of the evaluation of any new technology.

If, through diagnostic stewardship, we can move to a world where we are much more effective in targeting use of antibiotics, and so restricting inappropriate use, then we will have taken a great step forward in the ongoing battle against antimicrobial resistance.