1.1 Where does diagnostic stewardship fit in?

In the context of antimicrobial resistance (AMR), diagnostic stewardship is a systematic approach to address the role of the microbiology laboratory in clinical practice (Dyar et al., 2019). It goes hand in hand with programmes of antimicrobial stewardship (AMS): a multi-disciplinary, systematic approach to optimising the use of antimicrobials to improve patient outcome and limit the emergence of resistant pathogens while ensuring patient safety.

Studies suggest that AMS programmes are more effective when coupled with infection prevention and control (IPC): measures and diagnostic strategies where the clinicians and microbiology laboratory work together to make best use of the available resources in the local setting (Madden, 2018). This is shown in Figure 1.

Figure 1 The place of diagnostic stewardship and AMS in patient management (Savoldi et al., 2020).

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A figure showing who does what in diagnostic stewardship and patient management: a clinician makes the clinical evaluation and diagnostic hypothesis, and does the test ordering; a microbiology laboratory performs tests and communicates the results; the antibiotic stewardship team makes the right interpretation and puts the right application into clinical practice; and a clinician prescribes the appropriate antibiotic therapy.

Figure 1 The place of diagnostic stewardship and AMS in patient management (Savoldi et al., 2020).