{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:27:50Z","timestamp":1781188070570,"version":"3.54.1"},"reference-count":36,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2015,5,18]],"date-time":"2015-05-18T00:00:00Z","timestamp":1431907200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec id=\"S0899823X15001130_abs1\" sec-type=\"general\"><jats:title>OBJECTIVE<\/jats:title><jats:p>We found previously that inappropriate inpatient antimicrobial use was often attributable to erroneous diagnoses. Here, we detail diagnostic errors and their relationship to inappropriate antimicrobial courses.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15001130_abs2\" sec-type=\"general\"><jats:title>DESIGN<\/jats:title><jats:p>Retrospective cohort study<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15001130_abs3\" sec-type=\"general\"><jats:title>SETTING<\/jats:title><jats:p>Veterans Affairs hospital<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15001130_abs4\" sec-type=\"general\"><jats:title>PATIENTS<\/jats:title><jats:p>A cohort of 500 randomly selected inpatients with an antimicrobial course<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15001130_abs5\" sec-type=\"methods\"><jats:title>METHODS<\/jats:title><jats:p>Blinded reviewers judged the accuracy of the initial provider diagnosis for the condition that led to an antimicrobial course and whether the course was appropriate.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15001130_abs6\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>The diagnoses were correct in 291 cases (58%), incorrect in 156 cases (31%), and of indeterminate accuracy in 22 cases (4%). In the remaining 31 cases (6%), the diagnosis was a sign or symptom rather than a syndrome or disease. The odds ratio of a correct diagnosis was 4.3 (95% confidence interval [CI], 2.2\u20138.5) if the index condition was related to the reason for admission. When the diagnosis was correct, 181 of 292 courses (62%) were appropriate, compared with only 10 of 208 (5%) when the diagnosis was incorrect or indeterminate or when providers were treating a sign or symptom rather than a syndrome or disease (<jats:italic>P<\/jats:italic>&lt;.001). Among the 309 cases in which antimicrobial courses were not appropriate, reasons varied by diagnostic accuracy; in 81 of 111 cases (73%) with a correct diagnosis, incorrect antimicrobial(s) were selected; in 166 of 198 other cases (84%), antimicrobial therapy was not indicated.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15001130_abs7\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p>Diagnostic accuracy is important for optimal inpatient antimicrobial use. Antimicrobial stewardship strategies should help providers avoid diagnostic errors and know when antimicrobial therapy can be withheld safely.<\/jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol<\/jats:italic> 2015;36(8):949\u2013956<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2015.113","type":"journal-article","created":{"date-parts":[[2015,5,18]],"date-time":"2015-05-18T14:04:31Z","timestamp":1431957871000},"page":"949-956","source":"Crossref","is-referenced-by-count":45,"title":["Diagnostic Errors that Lead to Inappropriate Antimicrobial Use"],"prefix":"10.1017","volume":"36","author":[{"given":"Gregory A.","family":"Filice","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri M.","family":"Drekonja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Thurn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galen M.","family":"Hamann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobbie T.","family":"Masoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,5,18]]},"reference":[{"key":"S0899823X15001130_ref19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1276"},{"key":"S0899823X15001130_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.01.001"},{"key":"S0899823X15001130_ref13","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.13.1493"},{"key":"S0899823X15001130_ref4","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.8.972"},{"key":"S0899823X15001130_ref35","doi-asserted-by":"publisher","DOI":"10.3402\/meo.v16i0.5890"},{"key":"S0899823X15001130_ref24","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-133-2-200007180-00012"},{"key":"S0899823X15001130_ref20","volume-title":"Thinking Fast and Slow","author":"Kahneman","year":"2011"},{"key":"S0899823X15001130_ref10","unstructured":"European Centre for Disease Prevention and Control and European Medicines Agency. 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