Improper Antibiotic Use Often Due to Misdiagnosis: Study

Identifying illness correctly is key to drugs' effectiveness, researcher says

By Robert Preidt

Wednesday, May 20, 2015

WEDNESDAY, May 20, 2015 (HealthDay News) -- Misdiagnosis often leads to improper antibiotic use in hospitals, new research finds.

Incorrect antibiotic use can cause patient harm, reduce the effectiveness of antibiotics and increase health care costs, the researchers noted.

"Antibiotic therapies are used for approximately 56 percent of inpatients in U.S. hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses," study author Dr. Greg Filice said in a news release from the Society for Healthcare Epidemiology of America.

Filice, an internist with the Minneapolis Veterans Affairs Health Care System, and his colleagues analyzed 500 inpatient cases at the Minneapolis VA Medical Center. They found that inappropriate use of antibiotics occurred with 95 percent of patients who received an incorrect or indeterminate diagnosis, or those with an identified symptom but no diagnosis.

By comparison, incorrect use of antibiotics occurred in 38 percent of patients who received a correct diagnosis.

Overall, only 58 percent of patients received a correct diagnosis, researchers found. The most common misdiagnoses were pneumonia, cystitis, urinary tract infections, kidney infections and urosepsis (when an infection starts in the urinary tract and spreads to the bloodstream).

The study was published online May 18 in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The findings suggest that programs overseeing antibiotic use in hospitals would be more effective if designed to help providers make accurate initial diagnoses and to know when antibiotics can be safely withheld, Filice said.

The researchers said relying on intuition rather than proper analysis contributed to incorrect diagnoses and inappropriate use of antibiotics at hospitals. Other contributing factors on the part of staff: fatigue, sleep deprivation, mental overload, dealing with patients with a previous diagnosis from another health care provider, lack of clinical experience, and lack of experience with drug side effects.

"Diagnostic accuracy is integral to the safe use of antibiotics. In order to improve the use of antibiotics in health care, we must consider this challenge and look for tools and strategies that help clinicians decrease unnecessary and potentially harmful antibiotic use" Filice said.

SOURCE: Infection Control & Hospital Epidemiology, news release, May 18, 2015

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