Misdiagnosis of XXXX and inappropriate utilization of antibiotics: side effects of the 4-h antibiotic administration rule.

@entity1 @entity1133 @entity55 @entity854 @entity497
BACKGROUND: The 2003 Infectious Diseases Society of America guidelines for @entity497 ( @entity497 ) recommend the initiation of antibiotic therapy within 4 h of hospitalization. This quality indicator has been linked to the incentive compensation of third-party payers to hospitals. We evaluated the impact of this recommendation on the diagnosis of @entity497 and the utilization of antibiotics. METHODS: All @entity1 with a hospital admission diagnosis of @entity497 before publication of the guidelines (January to June 2003) and after publication of the guidelines (January-June 2005) were included. We collected data on clinical signs and symptoms on presentation, chest radiograph findings, blood cultures prior to therapy with antibiotics, time to antibiotic administration, @entity55 severity index (PSI) score, confusion, @entity1133 , respiratory rate, BP, and age >or= 65 years (CURB-65), and mortality. RESULTS: A total of 518 @entity1 were included in the study. More @entity1 in 2005 had a hospital admission diagnosis of @entity497 without @entity854 compared to 2003 (2005, 91 @entity1 [28.5%]; 2003, 41 @entity1 [20.6%]; p = 0.04), and more patients received antibiotics within 4 h of triage (2005, 210 @entity1 [65.8%]; 2003, 107 @entity1 [53.8%]; p = 0.007). Blood cultures prior to antibiotic administration increased (2005, 220 @entity1 [69.6%]; 2003, 93 @entity1 [46.7%]; p < 0.001). However, the final diagnosis of @entity497 dropped to 58.9% in 2005 from 75.9% in 2003 (p < 0.001). The mean (+/- SD) antibiotic utilization per @entity1 increased to 1.66 +/- 0.54 in 2005 compared to 1.39 +/- 0.58 in 2003 (p < 0.001). There were no significant differences in PSI or CURB-65 scores, or mortality. CONCLUSIONS: Linking antibiotic administration within 4 h of hospital admission (as a quality indicator) to financial compensation may result in an inaccurate diagnosis of @entity497 , inappropriate utilization of antibiotics, and thus less than optimal care.
