Intensivists' beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101585411 Publication Model: Electronic Cited Medium: Internet ISSN: 2047-2994 (Electronic) Linking ISSN: 20472994 NLM ISO Abbreviation: Antimicrob Resist Infect Control Subsets: MEDLINE

Original Publication: London : BioMed Central

Antimicrobial Stewardship* ; Attitude of Health Personnel* ; Molecular Diagnostic Techniques*; Anti-Bacterial Agents/therapeutic use ; Humans ; Intensive Care Units ; Qualitative Research ; United Kingdom

Background: Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians' endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians' beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care.
Methods: We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians' beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically.
Results: Clinicians' beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians' prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device's capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results.
Conclusions: Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests' capabilities and integration into clinical practice. Implementation strategies should bolster users' necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests' purpose and benefits, identifying and addressing clinicians' misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60-90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.

N Engl J Med. 2014 Mar 27;370(13):1198-208. (PMID: 24670166)
BMJ Qual Saf. 2022 Mar;31(3):199-210. (PMID: 34099497)
Semin Respir Crit Care Med. 2019 Aug;40(4):454-464. (PMID: 31585472)
Curr Opin Infect Dis. 2019 Aug;32(4):356-364. (PMID: 31135388)
J Hosp Infect. 2007 Apr;65(4):361-7. (PMID: 17350721)
Int J Antimicrob Agents. 2004 Apr;23(4):325-31. (PMID: 15081079)
Pharmacol Ther. 2021 Jan;217:107663. (PMID: 32805298)
Lancet Respir Med. 2020 Feb;8(2):182-191. (PMID: 31810865)
J Infect. 2020 Jan;80(1):1-7. (PMID: 31809764)
Antimicrob Resist Infect Control. 2012 May 30;1(1):20. (PMID: 22958425)
Chest. 2008 Mar;133(3):610-7. (PMID: 17989157)
Qual Quant. 2018;52(4):1893-1907. (PMID: 29937585)
J Med Eng Technol. 2015 Jan;39(1):44-53. (PMID: 25367721)
Eur J Clin Microbiol Infect Dis. 2017 Nov;36(11):1999-2006. (PMID: 27287765)
J Hosp Infect. 2019 Apr;101(4):426-427. (PMID: 30826342)
Semin Respir Crit Care Med. 2017 Jun;38(3):253-263. (PMID: 28578550)
Eur Respir J. 2017 Sep 10;50(3):. (PMID: 28890434)
Acad Med. 2014 Sep;89(9):1245-51. (PMID: 24979285)

Investigator: J Barber; L Shallcross; J Cuesta; M Peters; N Klein; P Moondi; J O'Grady; J High; C Russell; AM Swart; D Turner; S Singh
Keywords: Antimicrobial prescription; Intensive care; Rapid molecular diagnostics

0 (Anti-Bacterial Agents)

Date Created: 20210630 Date Completed: 20220126 Latest Revision: 20231107

20231107

PMC8243627

10.1186/s13756-021-00961-4

34187563