Practical considerations for implementation of syndromic panel and diagnostic stewardship in the era of syndromic panel testing.

Background: The significant advancements in the development of syndromic panel testing for infectious diseases have brought about a paradigm shift in the clinical microbiology laboratory and the practices of Infectious Diseases Physicians. Due to the considerable costs associated with these tests, it is crucial for laboratories and healthcare services to devise implementation strategies and prioritize diagnostic stewardship when incorporating these panels into the laboratory.

Objectives: This study aims to describe the implementation considerations and the diagnostic stewardship strategies for integrating syndromic panels in the clinical microbiology laboratory.

Sources: Peer-reviewed publications were searched through PubMed and Embase databases. Further citation search was carried out using Google Scholar.

Content: Evidence from clinical and laboratory studies on syndromic panels of bloodstream infection, meningitis and encephalitis, and pneumonia suggests that syndromic panels can improve antimicrobial optimization and shorten time to targeted therapy, particularly when implemented alongside antimicrobial stewardship interventions. However, there are limited numbers of randomized controlled trials, and many studies are observational, with variable endpoints and limited generalizability. Cost-effectiveness analyses are often model-based and lack real-world validation. Behavioural drivers of inappropriate test use are underexplored, highlighting the need for comprehensive diagnostic stewardship strategies. Effective implementation requires careful panel selection, local validation, and sustained collaboration between clinical microbiology and antimicrobial stewardship teams.

Implications: Incorporation of syndromic panel in clinical microbiology laboratory requires careful consideration of implementation and diagnostic stewardship strategies. Future research should focus on standardizing implementation frameworks, generating real-time cost-effectiveness data, and exploring decision-support tools including artificial intelligence to augment antimicrobial stewardship efforts as well as more evidence from low-resource settings. Additionally, qualitative research is needed to understand behavioural influences on test utilization and to develop interventions that promote appropriate use in real-world settings.