Is resistance gene testing required for AMS?

No, it is not a requirement, and it is possible to practice antimicrobial stewardship (AMS) without testing for genes. While molecular diagnostics and gene testing can significantly enhance AMS programs, there are several other strategies and tools that can be effectively employed to optimize antimicrobial use and reduce resistance. Here are key components of AMS that do not rely on gene testing:

• Antibiotic Guidelines and Protocols: Developing and adhering to evidence-based guidelines and protocols for antibiotic use can help ensure appropriate prescribing. These guidelines can be based on local antibiogram data and national or international recommendations.
• Education and Training: Educating healthcare providers about the principles of AMS, the importance of appropriate antibiotic use, and the risks associated with overuse and misuse can improve prescribing practices.
• Antibiotic Stewardship Teams: Establishing multidisciplinary teams, often including infectious disease specialists, pharmacists, and microbiologists, can help review and oversee antibiotic use, providing recommendations and interventions as needed.
• Review and Feedback: Regular review of antibiotic prescriptions with feedback to prescribers can help identify inappropriate use and promote more judicious prescribing. This can involve prospective audit and feedback or retrospective review of prescribing patterns.
• De-escalation and Streamlining Therapy: Starting with broad-spectrum antibiotics when necessary and then de-escalating to narrower-spectrum agents based on clinical judgment and culture results (even without molecular diagnostics) can reduce the use of broad-spectrum antibiotics.
• Dose Optimization: Ensuring that antibiotics are dosed appropriately based on pharmacokinetic and pharmacodynamic principles, patient characteristics, and infection site can optimize therapy and reduce resistance.
• Duration of Therapy: Promoting appropriate durations of antibiotic therapy to avoid unnecessarily prolonged courses can help reduce resistance and adverse effects.
• Infection Control Measures: Implementing robust infection control practices, such as hand hygiene, isolation precautions, and environmental cleaning, can help prevent the spread of resistant organisms.
• Surveillance: Monitoring antibiotic resistance patterns within the healthcare facility can inform local prescribing guidelines and help track the impact of stewardship interventions.
• Clinical Decision Support Systems (CDSS): Utilizing electronic health records and CDSS to provide real-time guidance and alerts for appropriate antibiotic use can support prescribers in making informed decisions.

While molecular diagnostics add value by providing rapid and precise information about pathogens and resistance mechanisms, effective antimicrobial stewardship can still be practiced using a combination of the above strategies. The key is a coordinated, multifaceted approach that promotes rational antibiotic use and addresses local needs and resources.