CONTINUING EDUCATION :: RESPIRATORY INFECTIONS AND ANTIMICROBIAL STEWARDSHIP Syndromic testing
A syndrome is a set of symptoms and signs that are correlated with each other and often with a specific disease. For example, a respiratory syndrome may include symptoms or signs such as fever, cough, muscle aches, elevated heart rate, or ab- normal laboratory results (e.g., white blood cell count). Patients may experience just a few of these symptoms which can make it challenging for a clinician to identify a causative pathogen based on non-specific symptoms alone. In addition, a patient’s ability to recover from a respiratory infection varies widely. Consider a patient with chronic obstruc-
tive pulmonary disease (COPD) or asthma, for example. These patients are more likely to become seriously ill from respiratory infections, as compared to a patient with no underlying lung or health conditions.7 These and other factors that impact patient outcomes include the type of pathogen, its resistance to treatment, the patient’s age and underlying health status, and importantly, the speed and accuracy of a diagnosis so proper treatment can begin promptly.
Misdiagnosis matters At the point of care, physicians do not have the tools to differ- entiate among overlapping symptoms. In a study comparing the results of early identification in an office against the results of PCR and RNA sequencing of samples from the same patients, the study team found that skilled medical observation without laboratory testing identified only 37 percent of the study’s pa- tients with respiratory tract infections.8
A brief retrospective
analysis demonstrated that multiplex testing identified 59 percent positive targets and over 90 percent of co-infections not detected by low-plex testing. Sensitive multiplex PCR panel testing is a fast and simple
way to accurately diagnose patients when multiple respiratory pathogens are circulating. In fact, the Centers for Disease Control and Prevention and the Academy of Medical Sciences “strongly support multiplex testing” in this situation.9,10
Syndromic testing
with multiplex molecular panels offers clinical labs a way to quickly distinguish between a broad array of respiratory patho- gens. Unlike traditional diagnostic methods, such as bacterial culture and microscopy, PCR tests can test for a host of pathogens and deliver accurate results in about an hour. Without question, the coronavirus disease pandemic brought the utility of multiplex PCR assays into sharp focus. By combining common pathogens capable of causing a specific syndrome into one panel, multiplex testing can reduce the time needed to provide a diagnosis and a precise therapeutic decision.11 Many clinical publications show that syndromic testing can support antimicrobial stewardship programs, improve patient outcomes, and reduce overall healthcare costs, lessening the impact of misdiagnosis.
Diagnostic and antimicrobial stewardship Many clinical publications show that syndromic testing can support antimicrobial stewardship programs, improve patient outcomes, and reduce overall healthcare costs, lessening the impact of mis- diagnosis. Syndromic panels, if implemented thoughtfully and in-
10 | SEPTEMBER 2023
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Figure 2. Roles of diagnostic and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics in the clinical setting.23
terpreted carefully, have the potential to improve antimicrobial use and patient outcomes through improved clinical decision making, optimized laboratory workflow, and enhanced antimicrobial and laboratory stewardship.12
Diagnostic stewardship refers to the ap-
propriate use of laboratory testing to guide patient management, optimize patient outcomes, and limit the spread of antimicrobial resistance. Partnership among clinical laboratories, pharmacists and infectious disease clinicians can ensure that the right tests are ordered for the right patients, and the information they provide is translated into appropriate treatment decisions.13 In turn, appropriate treatment decisions can advance antimi- crobial stewardship. Antimicrobial resistance is considered an urgent global health threat.14
In the United States, more than
2.8 million antimicrobial-resistant infections occur each year, and more than 35,000 people die as a result. The U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) includes a strategic goal to accelerate development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria.15
guide proper, evidence-based use of antibiotics16
Syndromic testing can — which do
not work on viral infections — and support global Antimicrobial Stewardship Programs (ASPs). To mitigate the misuse of antibiotics for viral respiratory in-
fections, the CDC provides education resources to help patients and clinicians recognize if their symptoms may be caused by a bacteria or virus (See Figure 1).17 The coronavirus pandemic increased awareness of diagnostic
stewardship programs that evaluated several testing platforms to ensure the right test was being ordered for the right patient. These programs also aimed to ensure that critical resources were being conserved and utilized appropriately. Since the pandemic has waned, diagnostic stewardship programs have continued to flourish and bring awareness to the relationship between diagnostic and antimicrobial stewardship to improve patient care (See Figure 2).23
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