Read the original publication https://www.sciencedirect.com/science/article/pii/S1470211824054496
https://doi.org/10.1016/j.clinme.2024.100264
SAS Journal review of the original article
The article “Key concepts in diagnosing infection – when to treat and when not to” provides a framework for clinicians to improve diagnostic accuracy in infections, reduce inappropriate antibiotic use, and support antimicrobial stewardship. Using a case study of a 79-year-old patient with multiple comorbidities, it explores practical diagnostic challenges and principles, focusing on:
- Urinary Tract Infections (UTIs):
- Highlights the limitations of diagnostic tests like urine dipsticks and emphasises contextual interpretation of catheter specimen urine (CSU).
- Recommends sending samples after catheter changes and avoiding unnecessary antibiotics to prevent antimicrobial resistance.
- Skin Ulcers:
- Explains the difficulty in distinguishing colonisation from infection in chronic ulcers.
- Suggests only swabbing when signs of active infection (e.g., erythema, pain) are present.
- Blood Cultures:
- Discusses techniques to minimise contamination and the importance of clinical correlation for low-grade pathogens (e.g., coagulase-negative staphylococci).
- Encourages multiple cultures to improve diagnostic accuracy, especially in prosthetic infections.
- Screening Swabs:
- Differentiates between colonisation and infection.
- Advises isolation and consideration of resistant pathogens when managing colonised patients.
- Source Control:
- Stresses the importance of removing infected prosthetic materials as part of treatment.
Expanded Discussion
This work underscores diagnostic stewardship—a critical element in reducing unnecessary healthcare interventions and combating antibiotic resistance. A systematic approach to interpreting microbiological results based on clinical context is vital in modern healthcare.
Emerging Areas of Interest:
- Artificial Intelligence in Diagnostics: Machine learning tools are increasingly used to support clinical decision-making by identifying infection patterns.
- Rapid Diagnostic Tools: Advances in PCR and molecular assays provide faster identification of pathogens, allowing for tailored antibiotic therapy.
- Global Antimicrobial Resistance (AMR): Increasing AMR rates necessitates a stronger emphasis on diagnostic stewardship and innovation in treatment strategies.
Links to Recent Related Publications
- CDC’s Antimicrobial Resistance Reports – Comprehensive AMR trends and solutions updates.
- WHO Global Action Plan on AMR – Outlines global strategies and initiatives to combat AMR.
- Nature Microbiology Review on Biofilms – Discusses biofilms and their role in persistent infections.
- NICE Guidance on Diagnosing UTIs – Details quality standards for diagnosing UTIs, referenced in the article.
- Clinical Microbiology Reviews on Blood Culture Contamination – Insights into minimising false positives in blood culture diagnostics.
These resources provide broader insights into the topic, contributing to improved diagnostic and therapeutic approaches. Let me know if you’d like more tailored research or in-depth analysis!
