Different Kind of Diagnostic Error? Lab Solutions for Antibiotic Overuse, Misuse

Ruth Ryan ruth at RYAN-GRAHAM.COM
Tue Aug 1 13:41:26 UTC 2017

Morgan DJ, Malani P, Diekema DJ. Diagnostic Stewardship-Leveraging the Laboratory to Improve Antimicrobial Use.
JAMA. Published online July 31, 2017. doi:10.1001/jama.2017.8531

Two-page free article available at http://jamanetwork.com/journals/jama/fullarticle/2647071?utm_medium=alert&utm_source=JAMAPublishAheadofPrint&utm_campaign=31-07-2017

Is this an elephant in the room of misdiagnosis? The widespread overuse and misuse of antibiotics.

This article proposes to build on suggested tools/interventions for creating diagnostic stewardship programs under the umbrella of antibiotic stewardship programs.
Excerpt: "...However, clinicians often order common tests for patients without symptoms specific for the disease process (i.e., those with a very low pretest likelihood of infection), e.g., Clostridium difficile stool testing among patients without diarrhea, or urine cultures among patients without symptoms referable to the urinary tract. When positive test results are obtained in these and other scenarios, unnecessary therapy is often prescribed, even though the results represent false-positive findings or colonization rather than true infection.1,2 The problem with ordering tests in the setting of low pretest likelihood of disease is magnified by the availability of increasingly sensitive molecular tests, many of which are combined into "syndromic" testing panels."

Nice model for looping in pathology/lab in efforts to improve diagnosis.


Medical writer, risk management/patient safety/CME
Cell (504) 256-8797, Email ruth at ryan-graham.com<mailto:ruth at ryan-graham.com>
Secretary, SIDM Board of Directors

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