Right test, right time, right action saves lives: WHO's clinical diagnostic stewardship manual strengthens AMR response

Antimicrobial resistance, or AMR, is the ability of bacteria and other organisms that cause infections to resist the medicines used to treat them. AMR is one of the most pressing global health threats of our time, putting lives, livelihoods and health systems at risk, and reversing decades of medical progress.

AMR threatens to undermine medical treatment of infections, including those that can complicate surgeries, compromise maternal and child health, and threaten cancer care, rendering both routine and extraordinary medical interventions increasingly risky.

Fighting AMR in the human health sector requires an integrated approach to optimizing diagnosis and treatment of bacterial infections, as well as enhancing measures to prevent and control transmission.

Clinical diagnostic stewardship is about health-care workers ordering the right diagnostic test, from the right patient, at the right time, using the right sample-collection techniques, and then interpreting and acting on the results in the right way. By correctly identifying the organisms responsible for infections, clinical diagnostic stewardship contributes to the diagnosis of hospital-associated infections and identification of hospital outbreaks, alerting infection prevention and control teams of the need to strengthen measures to limit transmission. By focusing on taking tests only when they will help to make a diagnosis, clinical diagnostic stewardship reduces over-testing, unnecessary use of scarce resources, and other aspects of low-value health care.

Clinical diagnostic stewardship also improves the quantity and quality of AMR surveillance data. Good surveillance data are central to fighting AMR by facilitating early detection of outbreaks and informing treatment guidelines and AMR control strategies.

"Improvements in clinical diagnostic stewardship will save lives by promoting accurate and timely diagnosis, leading to better individual patient management and outcomes, better-quality AMR surveillance data and reductions in low-value health care," emphasized Dr Saia Ma'u Piukala, WHO Regional Director for the Western Pacific.

New practical manual

Recognizing the importance of clinical diagnostic stewardship in the armory of actions to fight AMR, WHO has developed Strengthening Clinical Diagnostic Stewardship in the Western Pacific Region: A practical manual.

The manual is a practical, facility-oriented resource designed to support capacity-building in low- and middle-income countries. It explains what clinical diagnostic stewardship is and why it is important, describes steps that can be taken to strengthen clinical diagnostic stewardship practices and illustrates key learning points through clinical case studies.

The manual complements other existing WHO publications, including: Responding to outbreaks of antimicrobial-resistant pathogens in health-care facilities: guidance for the Western Pacific, Guidance on establishing national and local AMR surveillance systems in the Western Pacific Region and the GLASS manual for antimicrobial resistance surveillance in common bacteria causing human infection. These have been widely used by WHO during support missions and/or capacity-building workshops in many Western Pacific countries - including Brunei Darussalam, Cambodia, Fiji, Indonesia, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Tonga, Vanuatu and Viet Nam - thus contributing to strengthening national AMR responses.

The development of this manual was supported by the European Union and the governments of Japan and the United Kingdom of Great Britain and Northern Ireland (Fleming Fund).

WHO continues to support integrated approaches to advancing AMR interventions, helping to protect lives and preserve the efficacy of antimicrobial drugs, safeguarding future generations from the enduring threat of AMR.

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Note to editors:

The magnitude of AMR as a global threat was emphasized in September 2024 at the United Nations High-level Meeting on AMR and its Political Declaration, which set an ambitious target of reducing global mortality from AMR by 10% by 2030 (from the baseline in 2019).

Tackling AMR is a key pillar of One Health, which brings human, animal and environmental health together, recognizing they are inextricably linked. WHO Member States reiterated their commitment to making One Health a global public health priority at the first-ever high-level Global Summit on One Health held in April this year in Lyon, France.

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