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

Background: Antibiotic resistance is a serious problem worldwide. It is par ticularly 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 patien ts seen in the emergency department during a 3-month study. A physician, un aware of the results of the urine tests, reviewed the medical charts of pat ients 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 pa tients (49.5%), AAU was detected. There was no significant difference in AA U between patients with or without an infectious disease (53.0% vs 46.3%, r espectively; P=.41). For patients with infection, 34.8% of those with AAU h ad 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 compare d 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). Fo r patients without infection, 27.6% of those with AAU had a masked or misse d 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 depart ment was associated with a significantly increased risk for delayed and mas ked or missed diagnoses of infectious diseases and missed diagnosis of noni nfectious diseases.