The role of microbiological results in driving inappropriate antibiotic prescriptions.

IF 3.4 3区 医学 Q1 CRITICAL CARE MEDICINE
Current Opinion in Critical Care Pub Date : 2025-10-01 Epub Date: 2025-08-06 DOI:10.1097/MCC.0000000000001314
Patricia Munoz, Antonio Vena, Almudena Burillo, Emilio Bouza
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引用次数: 0

Abstract

Purpose of review: To highlight the unintended consequences of microbiological test results in driving inappropriate antimicrobial prescriptions, and to evaluate strategies - particularly from the perspective of diagnostic stewardship - that may mitigate this issue.

Recent findings: Despite the critical role of microbiological data in guiding appropriate antimicrobial therapy, several studies have demonstrated that misinterpretation of such results frequently leads to unnecessary treatments. Common pitfalls include overinterpretation of positive cultures from poorly collected or clinically unwarranted samples, misclassification of colonization vs. infection, and excessive reliance on test results in the absence of supporting clinical evidence. Emerging diagnostic stewardship interventions - ranging from restricting sample processing and modifying test reporting to implementing decision support tools - have shown promising outcomes in reducing overtreatment without compromising patient safety. Specific examples include urine and wound cultures, respiratory specimens, and the diagnosis of Clostridioides difficile infection. Furthermore, educational and system-level strategies such as the BLADDER score or selective result reporting can improve decision-making at various stages of the diagnostic process.

Summary: Microbiology laboratories play a pivotal role in antimicrobial stewardship and must actively support clinicians in avoiding diagnostic and therapeutic errors. While evidence supports multiple approaches to mitigate inappropriate prescriptions driven by microbiology results, their successful implementation requires interdisciplinary collaboration, tailored interventions, and ongoing evaluation of clinical impact. Diagnostic stewardship, when aligned with clinician education and robust reporting practices, is a crucial component in enhancing the accuracy of infection diagnosis and reducing antimicrobial overuse.

微生物的作用导致不适当的抗生素处方。
综述的目的:强调微生物检测结果导致不适当的抗菌药物处方的意外后果,并评估可能减轻这一问题的策略-特别是从诊断管理的角度。最近的发现:尽管微生物学数据在指导适当的抗菌药物治疗方面发挥着关键作用,但一些研究表明,对这些结果的误解经常导致不必要的治疗。常见的缺陷包括对收集不良或临床不可靠样本的阳性培养物的过度解释,对定植与感染的错误分类,以及在缺乏临床证据支持的情况下过度依赖检测结果。新兴的诊断管理干预措施——从限制样本处理和修改检测报告到实施决策支持工具——在减少过度治疗而不损害患者安全方面显示出有希望的结果。具体的例子包括尿液和伤口培养、呼吸道标本和艰难梭菌感染的诊断。此外,教育和系统层面的策略,如膀胱评分或选择性结果报告,可以改善诊断过程中各个阶段的决策。微生物实验室在抗菌药物管理中发挥着关键作用,必须积极支持临床医生避免诊断和治疗错误。虽然证据支持多种方法来减轻由微生物学结果驱动的不当处方,但它们的成功实施需要跨学科合作、量身定制的干预措施和持续的临床影响评估。诊断管理与临床医生教育和强有力的报告做法相一致,是提高感染诊断准确性和减少抗生素过度使用的关键组成部分。
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来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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