Clinical Scorecard: Establishment of an Integrated Approach for Prompt Diagnosis and Management of Severe Infections in a Spanish Tertiary Care Facility

At a Glance

Key Highlights

• Implementation of the rDTSI program significantly reduced time to pathogen-directed therapy and increased targeted therapy within 48 hours in pneumonia patients.
• Hospital length of stay decreased significantly after program implementation.
• In sepsis patients, diagnostic times and antimicrobial appropriateness (DOOR-MAT scores) improved, though other clinical outcomes remained unchanged.

Guideline-Based Recommendations

Diagnosis

• Activate predefined diagnostic profiles ('sepsis profile' or 'pneumonia profile') in electronic medical records to trigger rapid microbiological testing.
• Obtain microbiological samples immediately upon clinical suspicion of severe infection to enable rapid pathogen identification.

Management

• Initiate empirical antimicrobial therapy promptly after sample collection.
• Use rapid molecular diagnostic results to guide early pathogen-directed therapy and optimize antimicrobial appropriateness.
• Integrate rapid diagnostics within antimicrobial stewardship programs to improve treatment decisions.

Monitoring & Follow-up

• Monitor time from clinical diagnosis to pathogen-directed therapy as a key performance indicator.
• Assess antimicrobial appropriateness using tools such as DOOR-MAT scoring.
• Track length of hospital stay and mortality as clinical outcome measures.

Risks

• Delayed or inadequate empirical therapy is associated with worse clinical outcomes and higher mortality.
• Traditional diagnostic turnaround times (>48 hours) may delay appropriate treatment, especially in resistant infections.

Patient & Prescribing Data

Adults with severe pneumonia or sepsis undergoing microbiological sampling

Rapid diagnostics enabled earlier targeted therapy, increased appropriateness of antimicrobial use, and reduced hospital stay, supporting integration of rapid molecular methods into routine care.

Clinical Best Practices

• Implement rapid molecular diagnostic techniques with 24/7 laboratory availability to accelerate pathogen identification.
• Use electronic health record–based diagnostic profiles to standardize and prioritize testing workflows.
• Provide multidisciplinary training to clinical and laboratory staff to support rapid diagnosis and antimicrobial stewardship.
• Exclude confounding factors such as pandemic disruptions when evaluating program impact to ensure data validity.

References

• ATS/IDSA guideline on pneumonia diagnosis and management