Diagnostic Errors that Lead to Inappropriate Antimicrobial Use

Area of Science:

• Infectious Diseases
• Internal Medicine
• Health Services Research

Background:

• Inappropriate inpatient antimicrobial use is a significant concern.
• Previous findings indicated a link between erroneous diagnoses and suboptimal antimicrobial prescribing.

Purpose of the Study:

• To detail diagnostic errors in inpatient settings.
• To examine the relationship between diagnostic accuracy and the appropriateness of antimicrobial courses.

Main Methods:

• Retrospective cohort study of 500 randomly selected inpatients receiving antimicrobial therapy at a Veterans Affairs hospital.
• Blinded reviewers assessed the accuracy of initial provider diagnoses and the appropriateness of antimicrobial courses.
• Analysis included diagnostic accuracy rates, odds ratios for correct diagnoses, and reasons for inappropriate antimicrobial use.

Main Results:

• Diagnoses were correct in 58% of cases, incorrect in 31%, and indeterminate in 4%.
• Correct diagnoses were associated with a 4.3-fold increased odds of accurate diagnosis if related to the reason for admission.
• Appropriate antimicrobial use was significantly higher when diagnoses were correct (62%) compared to incorrect/indeterminate diagnoses (5%) (P<.001).

Conclusions:

• Diagnostic accuracy is a critical factor for optimizing inpatient antimicrobial use.
• Antimicrobial stewardship programs should incorporate strategies to mitigate diagnostic errors.
• Providers need guidance on safely withholding antimicrobial therapy when indicated.