Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study.

Autor:	Gupta A; Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA ashwing@med.umich.edu.; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Petty L; Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Gandhi T; Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Flanders S; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Hsaiky L; Department of Pharmacy, Beaumont Hospital, Dearborn, Michigan, USA., Basu T; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Zhang Q; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Horowitz J; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Masood Z; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Chopra V; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA., Vaughn VM; Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.; Division of General Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA.; Department of Population Health Science, The University of Utah School of Medicine, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2022 May; Vol. 31 (5), pp. 383-386. Date of Electronic Publication: 2022 Jan 05.
DOI:	10.1136/bmjqs-2021-013565
Abstrakt:	Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI and CAP are also commonly overdiagnosed, resulting in unnecessary antibiotic use and diagnostic delays. While much is known individually about overdiagnosis of UTI and CAP, it is not known whether hospitals with higher overdiagnosis of one also have higher overdiagnosis of the other. Correlation of overdiagnosis of these two conditions may indicate underlying hospital-level contributors, which in turn may represent targets for intervention. To evaluate the association of overdiagnosis of UTI and CAP, we first determined the proportion of hospitalised patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then, we used Pearson's correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. Finally, we assessed for 'diagnostic momentum' (ie, accepting a previous diagnosis without sufficient scepticism) by determining how often overdiagnosed patients remained on antibiotics on day 3 of hospitalisation. We included 14 085 patients treated for CAP (11.4% were overdiagnosed) and 10 398 patients treated for UTI (27.8% were overdiagnosed) across 46 hospitals. Within hospitals, the proportion of patients overdiagnosed with UTI was moderately correlated with the proportion of patients overdiagnosed with CAP (r=0.53, p<0.001). Over 80% (81.8% (n=952/1164) of UTI; 89.9% (n=796/885) of CAP) of overdiagnosed patients started on antibiotics by an emergency medicine clinician remained on antibiotics on day 3 of hospitalisation. In conclusion, we found overdiagnosis of UTI and CAP to be correlated at the hospital level. Reducing overdiagnosis of these two common infections may benefit from systematic interventions. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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