Across the Western Pacific, countries are fighting rising rates of antimicrobial resistance (AMR). In hospitals, accurate diagnosis and treatment depend on ordering the right diagnostic test for the right patient, collecting specimens in the right way, interpreting results correctly, and using the results to guide care. Clinical diagnostic stewardship is about targeting diagnostic testing, optimizing patient care, and reducing the impact of AMR.
The World Health Organization (WHO) recently published Strengthening Clinical Diagnostic Stewardship in the Western Pacific Region: A Practical Manual, a facility-oriented WHO resource to support capacity-building, particularly in low- and middle-income countries. It explains what clinical diagnostic stewardship is, why it matters, and what practical steps health facilities can take to strengthen it. Adult and paediatric clinical case studies are included to support learning and discussion in real-world settings.
The manual was launched at the webinar “Clinical Diagnostic Stewardship – An integral component of the national AMR response,” organized by WHO in the Western Pacific on 24 June 2026. The webinar attracted 734 participants from 50 countries and areas across all six WHO regions, including national AMR focal points, clinicians, microbiologists, pharmacists, nurses, hospital leaders, and partners.
Why does clinical diagnostic stewardship matter for patient care and AMR?
Diagnostic decisions sit at the center of how AMR is addressed at the facility level, said Dr Kidong Park, Director of Programme Management at WHO in the Western Pacific. “Clinical diagnostic stewardship is so important because diagnostic decisions have a direct impact on antimicrobial prescribing, patient outcomes, and patient safety.”
The clinical diagnostic stewardship pathway improves clinical outcomes, supports responsible antimicrobial use, reduces low-value care, and strengthens the quality of AMR surveillance data used for outbreak detection, treatment guidelines and policy as well strengthening future capacity to respond to AMR.
What does clinical diagnostic stewardship look like in practice?
Introducing the new manual, Dr Anne Brink, consultant for AMR at WHO, acknowledged that the term “clinical diagnostic stewardship” may be unfamiliar, though many facilities are already implementing parts of it in practice. The manual brings these practices together in a clear, practical framework that can be adapted across settings with different levels of resources and diagnostic capacity.
From Australia, Professor Kirsty Buising of the Royal Melbourne Hospital shared an adult care perspective, highlighting how over-testing and unnecessary interventions contribute to low-value care in hospitals, and how better clinical judgment and use of results support safer patient management.
In children, the stakes of diagnostic decision-making are especially high and distinguishing true infection from colonization is particularly important. “Children are not small adults,” said Dr Yuho Horikoshi of the Tokyo Metropolitan Children’s Medical Center, Japan. He emphasized the importance of clinical diagnostic stewardship to avoid unnecessary procedures, unnecessary antibiotic exposure and other forms of low-value care, while optimizing timely diagnosis and treatment in this vulnerable population.
In Malaysia, ordering blood cultures from the right patients and improving specimen quality to reduce contamination has strengthened patient care, reduced waste and built closer collaboration between microbiology and clinical services, according to Dr Mahirah Kamil Puat of Hospital Tengku Ampuan Rahimah.
How can clinical diagnostic stewardship practices be improved?
Clinical diagnostic stewardship is a shared responsibility across clinicians, microbiologists, pharmacists, nurses, laboratory staff and public health teams. Each of these professions has a different role to play at different steps of the diagnostic pathway – from test ordering through to interpreting and acting on results. Optimizing clinical care depends on collaboration across these professions.
The quality of the specimen is also key to the value of the result. Poor specimen collection, contamination, mislabelling or processing delays compromise diagnosis and patient care, regardless of how advanced laboratory technology is.
Microbiologists and laboratory teams are at the heart of testing, but are also clinical partners, supporting optimal test selection, specimen quality, rapid communication of critical results and interpretation of findings. Clinicians, in turn, must support laboratories by providing clear and complete clinical information and acting appropriately on results to guide treatment decisions.
Reflecting on challenges, participants identified inappropriate test ordering as the most common gap in clinical diagnostic stewardship practice, followed by delayed turnaround times, weak multidisciplinary communication, poor specimen quality, and limited use of results to support treatment decisions. Many also said the concept is useful and should be strengthened in their settings, with interest in using the manual for local discussion, staff orientation, antimicrobial stewardship, laboratory strengthening, and quality improvement.
How can countries and hospitals use the new manual?
“More tests are not always better,” said Dr Genevieve Howse, Acting Director of the Division of Health Systems and Services at WHO in the Western Pacific. “Low-value care includes unnecessary or poorly targeted testing, and failing to use results to review or de-escalate treatment. Clinical diagnostic stewardship helps make testing more purposeful and useful for care.”
Dr Howse encouraged Member States, hospitals, professional societies, and training institutions to use the new manual to strengthen clinical diagnostic stewardship to improve clinical practice and antimicrobial stewardship programmes, and support patient safety and health workforce development.
WHO remains committed to closely working with Member States and partners to fight AMR and improve patient outcomes.