Inappropriate use of antibiotics and the risk for delayed admission and masked diagnosis of infectious diseases - A lesson from Taiwan
Inappropriate use of antibiotics and the risk for delayed admission and masked diagnosis of infectious diseases - A lesson from Taiwan
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DOI：
10.1001/archinte.161.19.2366
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发表时间：
2001-10-22
影响因子：
--
通讯作者：
Kunin, CM
中科院分区：
文献类型：
--
作者：
Liu, YC;Huang, WK;Kunin, CM
背景：抗生素耐药性是一个严重的世界性问题。在台湾和环太平洋其他国家，抗菌药的使用尤其令人担忧。目的：确定来急诊科之前使用抗菌药是否与台湾一家大型综合医院延迟入院、掩盖或漏诊有关。方法：在为期3个月的研究中，对所有急诊科就诊的患者进行尿中抗菌素活性(AAU)的测定。一名医生在不知道尿检结果的情况下，查看了入院患者的病历，以确定入院时间是否推迟了至少7天，或者诊断被掩盖或漏诊。结果：在1182名患者中，有444人入院。220例患者(49.5%)检出AAU。感染性疾病患者与非感染性疾病患者的AAU差异无统计学意义(分别为53.0%和46.3%；P=.41)。对于有感染的患者，34.8%的AAU患者延迟入院，而非AAU患者只有21.6%(相对风险[RR]，1.61；95%可信区间[CI]，1.03-2.52；P=.03)。在无感染的患者中，36.2%的AAU患者延迟入院，而非AAU患者的延迟入院时间为31.1%(RR，1.16；95%CI，0.81-1.68；P=.64)。对于有感染的患者，48.7%的AAU患者被掩盖或漏诊，而非AAU患者的这一比例为25.5%(RR，1.91；95%CI，1.30-2.80；P<；.001)。在无感染的AAU患者中，27.6%的患者存在隐蔽或漏诊，而非AAU患者的隐蔽或漏诊比例为14.8%(RR，1.87；95%CI，1.11~3.17；P=0.02)。结论：急诊前使用抗菌药物与感染性疾病的延迟、隐蔽或漏诊和非感染性疾病的漏诊风险显著增加。
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 < .001). For patients without infection, 27.6% of those with AAU had a masked or missed diagnosis compared with 14.8% without AAU (RR, 1.87; 95% CI, 1.11-3.17; P=.02).Conclusion: Use of antimicrobial drugs before coming to an emergency department was associated with a significantly increased risk for delayed and masked or missed diagnoses of infectious diseases and missed diagnosis of noninfectious diseases.