Hospitals Frequently Misdiagnosis Pneumonia, Leading to Antibiotic Risks: Study

Patients who received a pneumonia misdiagnosis often had few symptoms and few medical tests performed before being placed on a full course of antibiotics

The findings of a new study raise further concerns about the growing risk of antibiotic resistance and unnecessary use of antibiotics, indicating that many individuals receive a pneumonia misdiagnosis in hospitals, resulting exposure to potentially harmful side effects of antibiotics, which should not be prescribed for their underlying condition.

Most individuals misdiagnosed with pneumonia are elderly and have dementia, so they may not be able to accurately convey symptoms to doctors, according to a report published last week in the JAMA Internal Medicine. Researchers also note that in some cases, doctors fail to conduct proper tests to confirm their diagnosis.

Pneumonia is an infection of the lungs that causes them to fill with fluid or pus. Symptoms can range from mild to severe, depending on whether the cause is bacterial or viral. Mild viral cases can often be managed at home without medication, but severe cases caused by bacterial infections require antibiotics, hospitalization, or both.

However, health experts say viral cases should not be treated with antibiotics; which are not designed to combat viruses. Taking antibiotics when not medically necessary can put patients at risk and increase the creation of antibiotic-resistant bacteria or what many researchers call “superbugs.”

In this latest study, researchers from the Veterans Affairs (VA) Ann Arbor Healthcare System and the University of Michigan Medical School studied more than 17,000 hospitalized patients diagnosed with community-acquired pneumonia (CAP) in 48 Michigan hospitals. They conducted medical record reviews and telephone calls with patients treated for pneumonia between July 2017 and March 2020, looking for patients who received antibiotics on day one or day two of treatment.

Out of 17 ,290 adults hospitalized with pneumonia during the study, the findings indicate 12% were misdiagnosed with pneumonia, and 88% of those were treated with a full course of antibiotics. More than one-quarter of patients who received a pneumonia misdiagnosis had less than two signs or symptoms of pneumonia, but were still treated with antibiotics, according to the data.

Patients who were older, had dementia, or altered mental status faced the greatest risk of being improperly diagnosed with pneumonia, the researchers determined. They also found that  in 74% of pneumonia misdiagnosis cases, doctors failed to perform x-rays or other accompanying tests to confirm a bacterial pneumonia infection.

Among the patients who were inappropriately diagnosed with pneumonia and received a full course of antibiotics, the data indicates 2% experienced adverse antibiotic side effects.

Pneumonia Misdiagnosis Leads to Antibiotic Overuse

Previous research has indicated antibiotic overuse is largely linked to prescribing habits in urgent care clinics and doctor overprescribing antibiotics for conditions they can not treat, like those seen in this study. Doctors often prescribe antibiotics out of caution or because patients insist, but not because the medical diagnosis calls for it.

Most patients treated for pneumonia and given antibiotics unnecessarily in this study were older and suffered from cognitive dysfunction, researchers noted. Conditions like Alzheimer’s disease and dementia can complicate diagnosing pneumonia, because other lung conditions that seniors often suffer from may have similar symptoms, they warned.

Additionally, pneumonia is very common among older adults, which may lead many doctors to simply assume certain symptoms mean the patient has pneumonia and inaccurately prescribe antibiotics, the researchers suggested. However, they warned that it is important to stop antibiotics once pneumonia or bacterial infection is ruled out.

“In this cohort study, inappropriate diagnosis of CAP among hospitalized adults was common, particularly among older adults, those with dementia, and those presenting with altered mental status,” the researchers concluded. “Full-course antibiotic treatment of those inappropriately diagnosed with CAP may be harmful.”