'Strengthening Antimicrobial Stewardship via Diagnostic Stewardship Education'.

Abstract

Background
Antimicrobial resistance (AMR) is a global health challenge requiring an integrated approach that includes antimicrobial stewardship (AMS), infection prevention and control (IPC), and diagnostic stewardship (DS). Diagnostic uncertainty drives antibiotic overuse. DS enhances accurate diagnoses by optimizing test selection, reducing unnecessary antibiotic use, and improving surveillance, ultimately refining prescribing practices and patient outcomes. Despite DS's potential to curb inappropriate prescribing and healthcare costs, its adoption remains limited due to low awareness and misconceptions among clinicians.
Methods
This cross-sectional pre-post study engaged 458 multidisciplinary participants to assess awareness regarding DS practices. An online educational intervention comprising five modules covered pre- and post-analytic practices, test interpretation, and the integration of DS with AMS.
Results
Out of 458 participants, 111 participants completed all tests in the five modules. There was a significant increase in knowledge, with mean test scores rising from 29.22 +- 5.80 to 35.45 +- 6.18 (p < 0.001) post-intervention. Overall knowledge of antimicrobial stewardship improved substantially, with mean correct responses rising from 58% pre-test to 71% post-test. AMR awareness increased from 83% to 90%, while report interpretation saw the greatest gain (43% to 63%), followed by AMS strategies (61% to 75%), pre-analytical processes (44% to 56%) and AMS actions (61% to 73%).However, some gaps remained in understanding the limitations of the Widal test, indications for respiratory cultures, redundant antibiotic cover, inappropriate drug-pathogen combinations, and the need to avoid unnecessary antimicrobials in asymptomatic bacteriuria.
Conclusion
The educational intervention led to marked improvements in both core awareness and applied stewardship competencies, especially enhancing appropriate test selection, result interpretation, and dispelling key diagnostic misconceptions. To sustain these gains and drive enduring behavioral change, regular refresher training, seamless integration of diagnostic stewardship into broader antimicrobial and infection prevention and control programs and periodic curriculum updates are essential.