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Unspecified diagnosis of infectious disease prompts unnecessary antibiotic use

06 Dec 2018

Noninfectious syndromes often lead to unnecessary antibiotic therapy, with risk factors including unspecified diagnosis of infectious disease and the absence of microbial testing, a study reports.

Researchers analysed 453 curative antibiotic therapies prescribed over 2 consecutive days through the same electronic medical records, obtaining data on the reason for hospitalization, comorbid conditions, suspected or definitive diagnosis of infection, and microbial analyses. They defined unnecessary antibiotic therapy as the recognition of noninfectious syndromes, nonbacterial infections, use of redundant antimicrobials and continuation of empirical broad-spectrum antimicrobials.

Hospitalization occurred in 201 cases (44 percent) due to an infectious disease. The main diagnoses were urinary tract infections (n=118; 26 percent), unspecified (n=104; 22 percent) and pulmonary infections (n=79; 17 percent). A total of 158 noninfectious syndromes were identified (35 percent).

An unspecified diagnosis occurred with greater frequency in the presence of a noninfectious syndrome: 60/104 vs 98/349 (58 percent vs 28 percent; p<0.001). Microbial samples were obtained in 296 cases (65 percent), allowing isolation of a pathogen in 156 cases (53 percent).

Unspecified diagnosis was significantly associated with the absence of a microbial sample (p=0.005). There were 169 cases (37 percent) of unnecessary antibiotic therapy, of which 106 were due to noninfectious syndromes.

Multivariate logistic regression analysis revealed two the modifiable risk factors for unnecessary antibiotic therapy, namely unspecified diagnosis (adjusted odds ratio [AOR], 1.83; 95 percent CI, 1.04–3.20) and absence of a blood culture (AOR, 5.26; 2.56–10.00).

In light of the present data, antimicrobial stewardship programmes should focus on diagnostic difficulties and microbial testing, with the latter facilitating antibiotic reassessment and therapeutic interruption.

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