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Unspecified diagnosis of infectious disease prompts unnecessary antibiotic use

5 days ago

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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Most Read Articles
5 days ago
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
4 days ago
Low-dose administrations of haloperidol after thoracic surgery does not appear to prevent postoperative delirium, according to a new study.
2 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.
Pearl Toh, 4 days ago
Apixaban slashes the risk of recurrent venous thromboembolism (VTE) by 90 percent in cancer patients compared with the low-molecular-weight heparin (LMWH) dalteparin, with no increase in major bleeding risk, according to the ADAM VTE study presented at ASH 2018.