Utility and Applicability of Rapid Diagnostic Testing in Antimicrobial Stewardship in the Asia-Pacific Region: A Delphi Consensus

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Abstract

Rapid diagnostic tests (RDTs) facilitate fast and accurate identification of infectious disease microorganisms and are a valuable component of multimodal antimicrobial stewardship (AMS) programs but are currently underutilized in the Asia-Pacific region. An experienced group of infectious diseases clinicians, clinical microbiologists, and a clinical pharmacist used a modified Delphi consensus approach to construct 10 statements, aiming to optimize the utility and applicability of infection-related RDTs for AMS in the Asia-Pacific region. They provide guidance on definition, types, optimal deployment, measuring effectiveness, and overcoming key challenges. The Grading of Recommendations Assessment, Development, and Evaluation system was applied to indicate the strength of the recommendation and the quality of the underlying evidence. Given the diversity of the Asia-Pacific region, the trajectory of RDT development will vary widely; the collection of local data should be prioritized to allow realization and optimization of the full benefits of RDTs in AMS.

Abstract

A group of experienced practitioners provide 10 consensus statements for guiding the use of rapid diagnostic tests in antimicrobial stewardship in the Asia-Pacific region, including definitions, types, optimal deployment, measuring effectiveness, and overcoming key challenges.

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Most cited references 43

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Gordon Guyatt, Andrew D Oxman, Elie A. Akl … (2011)

This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.

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Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies.

Ivan Diamond, Robert C Grant, Brian Feldman … (2014)

To investigate how consensus is operationalized in Delphi studies and to explore the role of consensus in determining the results of these studies. Systematic review of a random sample of 100 English language Delphi studies, from two large multidisciplinary databases [ISI Web of Science (Thompson Reuters, New York, NY) and Scopus (Elsevier, Amsterdam, NL)], published between 2000 and 2009. About 98 of the Delphi studies purported to assess consensus, although a definition for consensus was only provided in 72 of the studies (64 a priori). The most common definition for consensus was percent agreement (25 studies), with 75% being the median threshold to define consensus. Although the authors concluded in 86 of the studies that consensus was achieved, consensus was only specified a priori (with a threshold value) in 42 of these studies. Achievement of consensus was related to the decision to stop the Delphi study in only 23 studies, with 70 studies terminating after a specified number of rounds. Although consensus generally is felt to be of primary importance to the Delphi process, definitions of consensus vary widely and are poorly reported. Improved criteria for reporting of methods of Delphi studies are required. Copyright © 2014 Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Anucha Apisarnthanarak

Hong Bin Kim

Luke S P Moore

Yonghong Xiao

Sanjeev Singh

Yohei Doi

Andrea Lay-Hoon Kwa

Sasheela Sri La Sri Ponnampalavanar

Qing Cao

Shin-Woo Kim

Hyukmin Lee

Pitak Santanirand

Journal

Journal ID (nlm-ta): Clin Infect Dis

Journal ID (iso-abbrev): Clin Infect Dis

Journal ID (publisher-id): cid

Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

Publisher: Oxford University Press (US )

ISSN (Print): 1058-4838

ISSN (Electronic): 1537-6591

Publication date Collection: 01 June 2022

Publication date (Electronic): 19 October 2021

Publication date PMC-release: 19 October 2021

Volume: 74

Issue: 11

Pages: 2067-2076

Affiliations

Infectious Diseases Division, Thammasat University Hospital , Pathum Thani, Thailand

Infectious Diseases Division, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, Republic of Korea

Clinical Infection Department, Chelsea & Westminster NHS Foundation Trust , London, United Kingdom

Infection & Immunity, North West London Pathology, Imperial College Healthcare NHS Trust , London, United Kingdom

National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London , United Kingdom

State Key Lab for Diagnosis and Treatment of Infectious Diseases, 1st Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China

School of Medicine, Amrita Institute of Medical Sciences, Amrita University , Ponekkara, Kochi, Kerala, India

Division of Infectious Diseases, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA

Departments of Microbiology and Infectious Diseases, Fujita Health University School of Medicine , Toyoake, Japan

Pharmacy Department, Singapore General Hospital , Singapore

Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School , Singapore

Department of Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia

Department of Infectious Diseases, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine , Shanghai, China

Internal Medicine, Kyungpook National University Hospital , Daegu, Republic of Korea

Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine , Seoul, Republic of Korea

Clinical Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University , Bangkok, Thailand

Author notes

Correspondence: Anucha Apisarnthanarakm, Infectious Diseases Division, Thammasat University Hospital, Pathum Thani, Thailand ( anapisarn@ 123456yahoo.com ).

Article

Publisher ID: ciab910

DOI: 10.1093/cid/ciab910

PMC ID: 9187322

PubMed ID: 34665855

SO-VID: c483a04d-8882-4bc4-9369-8c3e39413b54

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 19 August 2021

Date: 08 October 2021

Date: 10 February 2022

Page count

Pages: 9

Funding

Funded by: National Institute of Health Research Imperial Biomedical Research Centre;

Funded by: National Institutes of Health, DOI 10.13039/100000002;

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Utility and Applicability of Rapid Diagnostic Testing in Antimicrobial Stewardship in the Asia-Pacific Region: A Delphi Consensus

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Most cited references 43

GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies.

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