Inappropriate use of antibiotics and the risk for delayed admission and masked diagnosis of infectious diseases: A lesson from Taiwan

Y. C. Liu, W. K. Huang, T. S. Huang, C. M. Kunin

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Antibiotic resistance is a serious problem worldwide. It is particularly alarming in Taiwan and other countries of the Pacific Rim, where antimicrobial drugs are used excessively. Objective: To determine whether use of antimicrobial drugs before coming to an emergency department was associated with delayed admission or masked or missed diagnoses at a large general hospital in Taiwan. Methods: Antimicrobial activity in urine (AAU) was determined in all patients seen in the emergency department during a 3-month study. A physician, unaware of the results of the urine tests, reviewed the medical charts of patients who were admitted to the hospital to determine whether admission was delayed for at least 7 days or the diagnosis was masked or missed. Results: Of the 1182 patients, 444 were admitted to the hospital. In 220 patients (49.5%), AAU was detected. There was no significant difference in AAU between patients with or without an infectious disease (53.0% vs 46.3%, respectively; P=.41). For patients with infection, 34.8% of those with AAU had a delayed admission, compared with only 21.6% without AAU (relative risk [RR], 1.61; 95% confidence interval [CI], 1.03-2.52; P=.03). For patients without infection, 36.2% of those with AAU had a delayed admission compared with 31.1% without AAU (RR, 1.16; 95% CI, 0.81-1.68; P=.64). For patients with infection, 48.7% of those with AAU had a masked or missed diagnosis, compared with 25.5% without AAU (RR, 1.91; 95% CI, 1.30-2.80; P

Original languageEnglish
Pages (from-to)2366-2370
Number of pages5
JournalArchives of Internal Medicine
Volume161
Issue number19
Publication statusPublished - Oct 22 2001
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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