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The Underlying Challenge of Pneumonia Misdiagnosis: Antibiotic Resistance and Adverse Side Effects

A growing concern in healthcare revolves around the frequent misdiagnosis and consequent unnecessary treatment of pneumonia in hospitalized adults. A recent study in JAMA Internal Medicine highlights this issue, revealing that a significant proportion of these misdiagnosed patients are given unwarranted antibiotic treatment, contributing to a host of consequences such as the rise in antibiotic resistance and antibiotic-associated adverse effects.

This research indicates that 12% of older adults treated for community-acquired pneumonia (CAP) during their hospital stay were erroneously diagnosed. Most alarming is that 88% of these misdiagnosed patients were administered a complete antibiotic treatment cycle, with 2% experiencing adverse reactions to the medication. Antibiotic misuse is a critical concern for infection prevention professionals as it is tied to a surge of antibiotic resistance.

The Centers for Disease Control and Prevention (CDC) estimates an alarming number of roughly 47 million antibiotic courses prescribed in the U.S each year for needless infections or treatments. Excessive use of antibiotics weakens the effectiveness of these drugs against bacteria, leading to antibiotic resistance. This phenomenon has severe implications, including limiting treatment options and complicating treatment pathways for infections.

Pneumonia can be primarily either community-acquired or hospital-acquired. CAP is a lung infection contracted outside of a hospital setting. Patients primarily get hospital-acquired pneumonia after being admitted to the hospital. While many CAP patients can be treated without hospitalization, certain high-risk groups, such as individuals with severe symptoms, serious medical conditions, the elderly, or patients failing to improve on antibiotics, might require hospital intervention. CAP is a common cause of hospital admittance in the U.S.

The Michigan-based research team, led by Ashwin B. Gupta, M.D. from the University of Michigan Health, conducted their study by examining patient records from the Michigan Hospital Medicine Safety Consortium. They looked at roughly 17,000 adults hospitalized across 48 Michigan hospitals between July 1, 2017, and March 31, 2020. These patients were initially admitted for general care but later diagnosed with pneumonia within the first two days of admission, and were consequently treated with antibiotics.

The team found that among these hospitalized patients, especially older adults or those with dementia and altered mental status, it was common to see an inappropriate diagnosis of CAP. Misdiagnosis often leads to unnecessary full courses of antibiotics treatment. The researchers underscored the importance of the X-ray in the diagnostic process. It helps differentiate pneumonia from other diseases with overlapping symptoms. Misdiagnoses not only delay the understanding of a patient’s true illness but also brings the risks associated with antibiotic therapy into play. These risks include antibiotic-related adverse effects and lead to an unintended elevation in antibiotic resistance.

Notably, the study did not specifically evaluate causality, highlighting that while there is a correlation between a full course of antibiotics and antibiotic-associated adverse effects, direct cause and effect are not concrete. The significant overlap between pneumonia symptoms and other conditions suggests that the study may have underestimated the instances of misdiagnoses. The researchers still hope that their study would provide a basis for healthcare providers, hospitals, and health systems to reassess and calibrate their pneumonia diagnosis accuracy among hospitalized patients.

Source: https://www.foxnews.com/health/pneumonia-misdiagnoses-common-hospitalized-adults-study-implications.amp

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