Rapid Diagnostic Test Value and Implementation in Antimicrobial Stewardship Across Low-to-Middle and High-Income Countries: A Mixed-Methods Review

Luke S P Moore; Maria Virginia Villegas; Eric Wenzler; Timothy M Rawson; Rita O Oladele; Yohei Doi; Anucha Apisarnthanarak

doi:10.1007/s40121-023-00815-z

Rapid Diagnostic Test Value and Implementation in Antimicrobial Stewardship Across Low-to-Middle and High-Income Countries: A Mixed-Methods Review

Infect Dis Ther. 2023 Jun;12(6):1445-1463. doi: 10.1007/s40121-023-00815-z. Epub 2023 Jun 1.

Authors

Luke S P Moore^{1

2

3}, Maria Virginia Villegas^{4

5}, Eric Wenzler⁶, Timothy M Rawson^{7

8}, Rita O Oladele⁹, Yohei Doi^{10

11

12}, Anucha Apisarnthanarak^{13

14}

Affiliations

¹ Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK. l.moore@imperial.ac.uk.
² Imperial College Healthcare NHS Trust, North West London Pathology, London, UK. l.moore@imperial.ac.uk.
³ NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, London, UK. l.moore@imperial.ac.uk.
⁴ Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia.
⁵ Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.
⁶ College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
⁷ NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, London, UK.
⁸ Centre for Antimicrobial Optimisation, Imperial College London, London, UK.
⁹ Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria.
¹⁰ Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
¹¹ Department of Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
¹² Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹³ Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
¹⁴ Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.

Abstract

Despite technological advancements in infectious disease rapid diagnostic tests (RDTs) and use to direct therapy at the per-patient level, RDT utilisation in antimicrobial stewardship programmes (ASPs) is variable across low-to-middle income and high-income countries. Key insights from a panel of seven infectious disease experts from Colombia, Japan, Nigeria, Thailand, the UK, and the USA, combined with evidence from a literature review, were used to assess the value of RDTs in ASPs. From this, a value framework is proposed which aims to define the benefits of RDT use in ASPs, separate from per-patient benefits. Expert insights highlight that, to realise the value of RDTs within ASPs, effective implementation is key; actionable advice for choosing an RDT is proposed. Experts advocate the inclusion of RDTs in the World Health Organization Model List of essential in vitro diagnostics and in iterative development of national action plans.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Antimicrobial stewardship programmes; High-, middle-, and low-income countries; Infectious disease RDT; Point-of-care testing; Rapid diagnostic tests.