Due to the wide and sometimes unnecessary application of antibiotics bacterial resistance is becoming a global issue, and research data show that, in recent years, there have been more than 1 million deaths annually due to drug-resistant bacterial infections worldwide (1). According to the World Health Organisation, if the drug-resistant situation cannot be effectively controlled, the number of deaths per year will rise to 10 million in 2050. How exactly to curb bacterial drug resistance and to ensure rational application of antibiotics has become an important issue in the field of global public health (2, 3). The importance of microbial pathogenicity testing has been increasing around the world, and many countries have introduced a series of testing guidelines. For example, the Centres for Disease Control (CDC) for the United States, Nigeria, and other countries have emphasized that clinicians should prescribe antibiotics based on the test report and improve the level of test delivery (4, 5). Therefore, the rational use of antibiotics is crucial, and the choice of antibiotics should in principle be based on the results of bacterial drug sensitivity tests. These tests require continuous improvement in the rate of microbiological specimen delivery to achieve the rational use of antibiotics according to the type of bacteria.

In recent years, to achieve the above goals, China’s health administration introduced the 2015 Edition of the Hospital Infection Management Quality Control Indicators and subsequently designated “increasing the rate of pre-treatment antimicrobial drug delivery for inpatients” as one of the top 10 national healthcare quality and safety improvement goals for 2021 and 2022. In 2022, a series of policy measures such as the Notice on Further Strengthening the Management of Clinical Application of Antimicrobial Drugs to Curb Bacterial Drug Resistance and the National Action Plan for Curbing Microbial Drug Resistance (2022–2025) were issued, emphasizing the strengthening of hospital informatization, standardization of diagnosis and treatment of infections, enhancement of pathogenetic diagnostic capacity, and advancement of the effective management of antimicrobial drugs (6). In 2023, another series of policies and measures were introduced to further promote the improvement of in-patient antimicrobial drug treatment and increase the rate of pre-treatment pathogenetic delivery of in-patient specimens. In 2023, a letter was issued on further promoting the improvement of the inpatient antimicrobial pre-treatment pathogenetic delivery rate, requiring medical institutions to attach great importance to the work of inpatient antimicrobial pre-treatment pathogenetic delivery so as to effectively reduce the detection rate of multi-drug-resistant bacteria (7). Early detection of causative pathogens and targeted antimicrobial therapy prevent the emergence of multidrug-resistant organisms (MDROs) through empirical treatment, effectively reducing MDRO infection rates (8).

However, the traditional data collection method calculates the detection rate of pathogenic specimens without considering the specific time of collection or applying temporal limits to the indicators, which can lead to biased statistical results. In this study, we collected data on the process of calculating the detection rate of pre-antibiotic therapy pathogenicity specimens from 2014 to 2023, including the time of antibiotic administration and the time of specimen delivery, analyzed the impact of different collection methods on the detection rate of pathogenicity specimens, and accurately analyzed the detection rate of pre-antibiotic therapy pathogenicity specimens. This provides a scientific basis for the continuous improvement of the detection rate of pathogenicity specimens, the rational use of antibiotics, and the reduction of drug-resistant bacteria.

The use of antibiotics involves all clinical departments and saves countless lives; it is an important cornerstone of modern medicine. However, unnecessary use of antibiotics can lead to serious health problems, and bacterial resistance is one of the risks (9). The rational application of antibiotics is key to improving therapeutic effect, reducing the incidence of adverse reactions, and reducing or delaying the occurrence of bacterial resistance and other adverse health effects. In principle, the selection of antimicrobial agents should be based on the pathogen’s type and its susceptibility to antimicrobial drugs, as determined by antimicrobial susceptibility testing (10). Therefore, healthcare institutions with the necessary facilities should ensure that patients clinically diagnosed with bacterial infections have appropriate, suitable specimens (particularly from sterile sites such as blood) promptly collected and sent for pathogen testing prior to initiating antimicrobial therapy (11). The results of this study showed that the number of healthcare units collecting data increased year by year (to 105 in 2023), and the scope of coverage expanded from seven municipalities to 16 in the province. The increase in the number and scope of units means that the data on the pathogenicity delivery rate are more representative, laying a solid foundation for further improving the province’s pre-treatment pathogenicity delivery rate of antimicrobial drugs.

Pathogen testing conducted before antibiotic treatment emphasizes the critical need for identifying the causative pathogen prior to initiating therapy. The calculation of the indicator requires that the time of specimen collection should be earlier than the time of antibiotic use, and an accurate time of specimen detection and antibiotic use must be obtained. In the ‘Guidelines for Special Action to Improve the Rate of Pathogenesis Delivery and Testing of Inpatients before Antimicrobial Drug Therapy’, it is required that medical institutions should ‘improve the information system related to specimen testing, strengthen the informatization management of medical prescriptions, realize real-time monitoring and early warning, and improve the efficiency of targeted treatment with antimicrobial drugs’ (12). However, at present, there are problems such as inaccurate monitoring data, difficulty in capturing raw data, and low levels of monitoring efficiency and quality in China’s hospital infection informatization construction (13). In clinical practice, empirical treatment without microbiological evidence is frequently employed, which often leads to the selection of inappropriate antibiotics (14). Compared to empirical therapy, treatment guided by bacterial culture tests yields superior outcomes in the management of urinary tract infections. Routine urine cultures should be encouraged to guide the selection of effective antibiotics and reduce antimicrobial resistance (15).

The traditional management of pathogenicity specimen detection for the department is to collect samples, which are then transferred to the laboratory; this management specimen detection efficiency is not high and can easily to lead to antimicrobial drug abuse. At present, 47.37–75.17% (16), hospitals believe that as long as the use of antibiotics for specimen testing can be, statistical indicators without time limits. But such statistics will bias the results. In the results of this study, the traditional way of collecting pre-treatment antibiotic pathogenicity specimen detection rate increased from 32.84 to 67.48%, while the actual pathogenicity specimen detection rate only increased from 7.67 to 38.38% (p < 0.01). Therefore, China’s health administration issued the Notice of the General Office of the National Health and Wellness Commission on Continuously Improving the Management of Clinical Application of Antimicrobial Drugs in 2020 and, in 2021 and 2022, further made ‘increasing the rate of pre-treatment pathogenicity testing of antimicrobial drugs in hospitalized patients’ one of the top 10 goals of national healthcare quality and safety improvement (17). Policies and measures require strengthening infection prevention and control, improving the capacity of infection control management, and acknowledging the role of infection control in antimicrobial drug management. Hospitals must also improve information technology construction to help the scientific management of antimicrobial drugs and improve the level of monitoring and analyses. Multi-departmental collaboration mechanisms have been established in different levels of hospitals to strengthen information technology construction, enhance data interconnection and interoperability, carry out MDT discussions, and strengthen the training of medical staff and other comprehensive interventions to accurately collect data and improve the rate of pre-treatment pathogenicity testing of antibiotics, so as to provide an accurate basis for the rational use of drugs in the clinic (18). In addition, this study found that, compared with 2014, the percentage of the number of people tested for pathogenicity specimens after 0–12 h of antibiotic treatment in Shandong Province in 2023 decreased from 26.74 to 25.10%, which suggests that, although the pre-treatment pathogenicity specimens before antibiotic treatment were significantly elevated, the percentage of specimens delayed for 12 h was still high. It is necessary to further increase the intervention for detection within 12 h of antibiotic treatment to further improve the detection rate of pathogenicity specimens before antibiotic treatment.

In the above study, we analyzed the reasons limiting the rate of pre-treatment antibiotic pathogenicity specimen testing: (1) Clinical aspects: a lack of awareness of the rate of pre-treatment antibiotic pathogenicity specimen testing by medical staff, empirical dosing and fluke mentality, and a lack of guidance on reporting and application of guidelines. A survey of 340 physicians and microbiologists in 58 low- and middle-income countries confirmed that guidelines are the most effective antimicrobial stewardship intervention to change clinicians’ antibiotic prescribing behavior. Over a 12-month intervention period, the antibiotic prescribing rate for a decision support tool that provided clinicians with guideline recommendations was 98.7 prescriptions per 1,000 patient-years, compared with 107.6 prescriptions in the usual care group (19). (2) Informatics: one goal of using informatics to support clinical decision-making is to prevent unnecessary antibiotic use (20), and inadequate and untimely information systems similarly constrain the rate of improvement in the testing of antimicrobial pre-treatment pathogenetic specimens. (3) Personnel: bacterial culture programs are not carried out due to long culture times, few sterile specimens, poor implementation of bilateral double vials for blood cultures, and poor local development (21). A study showed that the availability of accessible personnel, testing technology, and other resources affect antimicrobial stewardship (22).

The rational use of antibiotics involves several departments in the hospital, and under the multidisciplinary cooperation model, resources are shared among departments to improve the pathogenicity delivery rate (23). To address the reasons constraining the testing rate of pathogenicity specimens before antibiotic treatment, we set up a project management team integrating administrative management and clinical operation, including functional departments (Infection Management Department, Medical Affairs Department, Nursing Department, and Performance Department), clinical departments (non-compliant departments + poorly executed departments), and safeguard departments (Information Centre, Pharmacy Department, Microbiology Department, and Administration Department). We analyzed the common problems in pathogenicity specimen testing in different levels of medical institutions across the province, provided timely feedback on the problems, and carried out targeted training and MDT case discussions to shorten the time limit for reporting test items in the microbiology room (TAT) to achieve an increase in the rate of antibiotic pathogenicity specimen testing. Dai et al. (24) found that implementing a PDCA (Plan-Do-Check-Act) cycle within a Quality Control Circle’s (QCC) efforts for quality control could increase the inpatient antibiotic pre-treatment pathogenicity specimen detection rate, thereby effectively guiding the rational use of medication in the clinic. Given that staffing constraints compel many hospitals worldwide to rely on conventional workflows, a multi-departmental collaboration mechanism should be established under such circumstances. This would clarify departmental responsibilities and refine the operational protocols of the hospital’s specialized working group for pre-processing antimicrobial drug susceptibility testing and submitting pathogenic specimens. Conducting multidisciplinary team (MDT) discussions and specialized training to implement effective clinical guidance with timely feedback should also be carried out. Training programs should be implemented for healthcare personnel to enhance awareness of pathogen specimen testing, thereby improving detection rates.

In summary, the detection rate of pre-antibiotic therapy pathogenicity specimens in hospitalized patients in Shandong Province from 2014 to 2023 showed an increasing trend, but the delay of 12 h to send specimens for testing needs to be further improved. Systematically integrating research findings on enhancing pathogen testing rates into future antimicrobial stewardship programs hinges on the codification of validated measures into standard operating procedures, complemented by research-data-driven precision training. This transforms the attitude of healthcare professionals from passively complying to actively understanding. Concurrently, establishing a monitoring, feedback, and performance management system centered on submission rates as a core metric will drive continuous improvement. Strengthening multidisciplinary collaboration between infection control departments, microbiology laboratories, and clinical pharmacists to jointly interpret data and formulate strategies will ultimately build a long-term antimicrobial stewardship mechanism transitioning from ‘empirical prescribing’ to ‘precision targeting’. This will enhance healthcare quality and curb bacterial resistance.