Diagnostic Errors Often Contribute to Antibiotic Misuse

Patients inaccurately diagnosed by their health care providers are more likely to receive inappropriate antibiotics that can lead to drug resistance, clinical failure, and adverse events.

A new study published in Infection Control & Hospital Epidemiology evaluated both the accuracy of diagnoses and the appropriateness of prescribed antimicrobial courses among 500 inpatient cases at the Minneapolis Veterans Affairs Medical Center.

The research team found 95% of patients who received an incorrect or indeterminate diagnosis were prescribed inappropriate antibiotics, compared with 38% of those correctly diagnosed. The authors also determined only 58% of patients received a correct diagnosis, indicating a higher rate of diagnostic errors in this study than previous research unrelated to antibiotic use.

“Antibiotic therapies are used for approximately 56% of inpatients in US hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses,” said lead study author Greg Filice, MD, in a press release. “The findings suggest that antimicrobial stewardship programs could be more impactful if they were designed to help providers make accurate initial diagnoses and to know when antibiotics can be safely withheld.”

The researchers provided a number of possible explanations for inaccurate diagnoses, suggesting they might result from providers who are:

• Relying upon intuition rather than analytical processes;
• Fatigued, sleep deprived, or experiencing cognitive overload;
• Treating patients who had been diagnosed previously by another provider;
• Lacking clinical and personal experience with adverse events.

The most common misdiagnoses in the study were pneumonia, cystitis, urinary tract infections, kidney infections, and urosepsis.

“Diagnostic accuracy is integral to the safe use of antibiotics,” Dr. Filice stated. “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.”