Diagnostic stewardship perceptions and practices among microbiology laboratories: a national survey from the American Society for Microbiology

Diagnostic stewardship (DxS) is a key activity for providing effective and efficient testing strategies for patient care. Complex test menus and result interpretation, high costs, limited reimbursements, and other factors necessitate DxS practices in clinical microbiology. We conducted a national survey of clinical microbiologists on their perceptions and practice of DxS in infectious diseases (ID) diagnostics. The 119 respondents (83 clinical directors, 33 operational leaders, and three trainees) indicated that DxS was practiced at their institution “some” (50.4%) or “most” (23.5%) of the time. Most respondents (>95%) had infection prevention and control and antimicrobial stewardship committees at their institutions. Academic medical center laboratories (AMCs) more often reported having microbiology consultation service, DxS/laboratory utilization committee, or official laboratory formulary than community hospital laboratories ( P ≤ 0.001). Respondents identified ID providers (79.0%) and clinical laboratory directors (74.8%) as the most common participants in their DxS activities. Leveraging informational technology (IT) was considered the most effective strategy (78.2%), and antimicrobial stewardship and/or ID collaboration (52.1%) was the most valuable resource for supporting DxS. The biggest challenge was time and personnel resources (52.1%). Respondents highlighted molecular testing, including syndromic panels (22.7%) and sequencing-based assays (21.0%), as a top priority for DxS efforts, followed by culture-based testing (20.2%). AMC respondents more likely considered sequencing assays as highest priority than other respondents ( P < 0.001). These data provide a valuable baseline for understanding the state of DxS in clinical microbiology laboratories. Key challenges include personnel resources and opportunities include engaging with ID providers and utilization of IT tools for DxS initiatives.

IMPORTANCE

At a time when microbiology test menus are expanding with costly molecular diagnostics while workforce shortages and reimbursement constraints persist, we conducted a national survey-based study of clinical microbiology professionals to capture their perceptions and practice of diagnostic stewardship. Results from 119 clinical microbiologists identified several common challenges as well as key differences between respondents from different institutional types as well as between respondents fulfilling different professional roles. The survey additionally identified diagnostic stewardship interventions regarded as most effective, factors most important in prioritization of stewardship efforts, and breadth of roles participating in diagnostic stewardship for microbiology tests. These unique observations into the state of diagnostic stewardship in clinical microbiology laboratories help establish a baseline for future research and guideline development in infectious disease testing.