Diagnostic Errors Lead to Inappropriate Antimicrobial Use

Misdiagnoses can lead to increased risk of incorrect antibiotic use, threatening patient outcomes and antimicrobial efficacy, while increasing healthcare costs.

All antimicrobial use establishes selective pressure that contributes to the relentless emergence of resistance in a broad array of pathogens and antimicrobial stewardship programs have been introduced to improve antimicrobial therapy, but in most cases improvements are modest.

Infectious disease specialists at the Minneapolis Veterans Affairs Health Care System, (Minnesota, MN, USA) and their university colleagues, conducted a retrospective cohort study at their Medical Center (MVAMC), evaluating 500 inpatient cases to examine provider diagnoses, categorized as either correct, indeterminate, incorrect, or a sign or symptom consistent with an infectious disease rather than a specific syndrome or disease, and to determine whether the antimicrobial course prescribed was appropriate.

The scientists found that 95% of patients with an incorrect or indeterminate diagnosis, or with a symptom identified but no diagnoses made, were given inappropriate antibiotics. By comparison, only 38% of patients who received a correct diagnosis were incorrectly given antibiotics. The inappropriate use of antibiotics contributes to antibiotic resistance, clinical failure, adverse drug events, and excessive costs. Additionally, they found that overall, only 58% of patients received a correct diagnosis, indicating that diagnostic errors were more prevalent in their study than in previous studies unrelated to antimicrobial use. The most common incorrect diagnoses identified by the specialists were pneumonia, cystitis, urinary tract infections, kidney infections and urosepsis.

The authors concluded that the impact of diagnostic accuracy on the appropriateness of antimicrobial therapy and they provide a detailed analysis of types and predictors of diagnostic errors and their relationship to types of inappropriate antimicrobial use. These findings suggest that more studies are needed to elucidate mechanisms of diagnostic errors related to antimicrobial prescribing. They also suggest that antimicrobial stewardship programs could increase their impact if they were designed to help providers make accurate initial diagnoses and to help providers know when antimicrobial therapy can be safely withheld.

Gregory A. Filice, MD, lead author of the study, said, “Diagnostic accuracy is integral to the safe use of antibiotics. In order to improve the use of antibiotics in healthcare, we must consider this challenge and look for tools and strategies that help clinicians decrease unnecessary and potentially harmful antibiotic use.” The study was published on May 18, 2015, in the journal Infection Control & Hospital Epidemiology

Related Links:.
Minneapolis Veterans Affairs Health Care System