March 25, 2024
2 min read
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Key takeaways:
- Among hospitalized adults treated for community-acquired pneumonia, around 12% received an inappropriate diagnosis.
- Most inappropriately diagnosed patients receive full antibiotic courses.
Around one in eight hospitalized adults treated for community-acquired pneumonia in a Michigan study were inappropriately diagnosed, and most of those patients received unneeded antibiotics, according to a study.
“For patients at high risk of poor outcomes from delayed treatment of community-acquired pneumonia (CAP), it may be pertinent to empirically prescribe antibiotics while finishing diagnostic evaluation,” Ashwin B. Gupta, MD, a clinical associate professor at University of Michigan Health, and colleagues wrote.
Data derived from Gupta AB, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2024.0077.
However, according to Gupta and colleagues, “For patients at high risk of poor outcomes from delayed treatment of CAP, it may be pertinent to empirically prescribe antibiotics while finishing diagnostic evaluation. In these populations, guidelines recommend reconsideration, de-escalation, and cessation of antibiotics within 48 to 72 hours once infection has been ruled out. In the present study, we found little evidence of antibiotic cessation.”
According to estimates, roughly one-third of misdiagnoses in the United States are infections of some sort, and pneumonia is among the top five misdiagnosed conditions.
Gupta and colleagues analyzed data on more than 17,000 adults hospitalized for CAP between July 1, 2017, and March 31, 2020, at 48 hospitals in Michigan.
They included patients who were admitted to the hospital for pneumonia and received antibiotics on day 1 or 2 of hospitalization. Among those patients, the median age was 71.8 years, and just over half of participants were female.
Of the more than 17,000 included patients, 12% met criteria for inappropriate diagnosis of CAP, according to the study, and 87% of those patients received full antibiotic courses. Among those receiving full courses, 2.1% had an antibiotic-associated adverse event.
Patients who were inappropriately diagnosed with CAP were more likely to be older and to have dementia or another type of altered mental status, according to the study. These populations are often more likely to be misdiagnosed with other conditions as well, Gupta and colleagues wrote.
Gupta and colleagues suggested that availability bias — the tendency to make decisions based on information that comes quickly to mind — nonspecific or overlapping symptoms, historical quality metrics and local policies, procedures or cultures may have significantly contributed to inappropriate diagnoses of CAP.
An initiative in Michigan to improve antibiotic prescribing practices in hospitals showed that interventions such as benchmarking, sharing best practices and pay for performance can help reduce the length of antibiotic courses.
“Longer durations of antibiotics are known to be associated with increased morbidity and delayed diagnosis of underlying conditions,” Gupta and colleagues wrote. “Particularly, older patients who may have more comorbid diseases, or who are more likely to be taking medications that interact with antibiotics, are at high risk of harm from antibiotics and delayed diagnosis.”
References:
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Sources/Disclosures
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Disclosures:
Gupta reports no relevant financial disclosures. Please see the study for the other authors’ relevant disclosures.
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