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Diagnostic Errors that Lead to Inappropriate Antimicrobial Use

Published online by Cambridge University Press:  18 May 2015

Gregory A. Filice ,
Dimitri M. Drekonja ,
Joseph R. Thurn ,
Galen M. Hamann ,
Bobbie T. Masoud  and
James R. Johnson
Gregory A. Filice*
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Dimitri M. Drekonja
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Joseph R. Thurn
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Galen M. Hamann
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
Bobbie T. Masoud
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
James R. Johnson
Affiliation:
Infectious Disease Section, Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Infectious Disease Section, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
*
Address correspondence to Gregory A. Filice, MD, Infectious Disease Section (111F), Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN 55417 ([email protected]).
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Abstract

OBJECTIVE

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.

DESIGN

Retrospective cohort study

SETTING

Veterans Affairs hospital

PATIENTS

A cohort of 500 randomly selected inpatients with an antimicrobial course

METHODS

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<.001). Among the 309 cases in which antimicrobial courses were not appropriate, reasons varied by diagnostic accuracy; in 81 of 111 cases (73%) with a correct diagnosis, incorrect antimicrobial(s) were selected; in 166 of 198 other cases (84%), antimicrobial therapy was not indicated.

CONCLUSIONS

Diagnostic accuracy is important for optimal inpatient antimicrobial use. Antimicrobial stewardship strategies should help providers avoid diagnostic errors and know when antimicrobial therapy can be withheld safely.

Infect Control Hosp Epidemiol 2015;36(8):949–956

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 949 - 956
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. Information presented in this article was previously presented in Program and Abstracts, ID Week, Philadelphia, Pennsylvania, October 8–12, 2014.

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