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Diagnostic Errors that Lead to Inappropriate Antimicrobial Use.

Gregory A Filice1, Dimitri M Drekonja1, Joseph R Thurn1

  • 11Infectious Disease Section,Department of Medicine,Minneapolis Veterans Affairs Health Care System,Minneapolis,Minnesota.

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Accurate diagnoses are crucial for appropriate inpatient antimicrobial use. Diagnostic errors significantly increase the risk of incorrect antimicrobial prescriptions, highlighting the need for improved diagnostic strategies in hospitals.

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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.