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- Title
A surgical sieve with one hole? Over diagnosis of infections and overuse of antibiotics on general medical wards.
- Authors
Rajasekar, N.; Guest, W.; Bodansky, H. J.
- Abstract
The aim of this study is to discern if infections are over diagnosed and over treated with antibiotics in patients who are admitted to hospital. This study analysed the decision to prescribe antibiotics; initially based on the evidence present at the time of diagnosis, and then retrospectively, taking into account the result of investigations and the patients' response to treatment. 100 consecutive medical files of patients discharged from general medical wards at St. James University Hospital, Leeds, UK, were analysed using medical notes and results from biochemistry, microbiology, haematology and radiology investigations. Patients diagnosed with an infection within 48 hours of admission and those diagnosed after 48 hours were analysed further. Patients on long term antibiotics for prophylaxis were excluded. There were 68 men and 32 women with a mean age of 69.75±14.1 years. 60% of patients received antibiotics for an infection but only 58% of the antibiotic courses prescribed were clinically justified. An infection was diagnosed on admission in 47 patients and 20 further infections were diagnosed after 48 hours of admission. Retrospectively, there was no evidence to support the diagnosis of an infection in 46% of patients on admission and none for 45% of those diagnosed after 48 hours of admission. They received up to eight courses of antibiotics during admission. A urinary tract infection was the most misdiagnosed infection on admission and pneumonia was misdiagnosed most commonly 48 hours after admission. Patients who received two or more antibiotics stayed in hospital longer than those who received one or no antibiotics (Mann Whitney U-Test generated a p value <0.0001). The study highlights that infections are over diagnosed and over treated in general medical in-patients, putting them at risk of antibiotic-associated complications, including diarrhoea.
- Subjects
INFECTION; DRUG overdose; ANTIBIOTICS; HOSPITAL wards; DISEASE management; DIAGNOSIS; ANTIBIOTIC overuse
- Publication
Mid Yorks Medical Journal, 2015, p19
- ISSN
2043-9695
- Publication type
Article