Diagnostic Errors that Lead to Inappropriate Antimicrobial Use

We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses. Retrospective cohort study. Veterans Affairs hospital. A cohort of 500 randomly selected...

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Bibliographic Details
Published in:Infection control and hospital epidemiology 2015-08, Vol.36 (8), p.949-956
Main Authors: Filice, Gregory A, Drekonja, Dimitri M, Thurn, Joseph R, Hamann, Galen M, Masoud, Bobbie T, Johnson, James R
Format: Article
Language:English
Subjects:
Accuracy
Aged
Anti-Bacterial Agents - therapeutic use
Antimicrobial agents
Bacterial Infections - diagnosis
Bacterial Infections - drug therapy
Cystitis - diagnosis
Cystitis - microbiology
Diagnostic Errors
Electronic health records
Female
Hospitals
Humans
Hypotheses
Inappropriate Prescribing
Infectious diseases
Male
Medical Audit
Medical diagnosis
Medical errors
Medical records
Middle Aged
Nursing
Pneumonia - diagnosis
Pneumonia - microbiology
Pyelonephritis - diagnosis
Pyelonephritis - microbiology
Random Allocation
Retrospective Studies
Single-Blind Method
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Summary:We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses. Retrospective cohort study. Veterans Affairs hospital. A cohort of 500 randomly selected inpatients with an antimicrobial course. Blinded reviewers judged the accuracy of the initial provider diagnosis for the condition that led to an antimicrobial course and whether the course was appropriate. RESULTS The diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the diagnosis was a sign or symptom rather than a syndrome or disease. The odds ratio of a correct diagnosis was 4.3 (95% confidence interval [CI], 2.2-8.5) if the index condition was related to the reason for admission. When the diagnosis was correct, 181 of 292 courses (62%) were appropriate, compared with only 10 of 208 (5%) when the diagnosis was incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease (P
ISSN:0899-823X
1559-6834
DOI:10.1017/ice.2015.113