SHM Converge Scientific Abstract ePoster Gallery-Overdiagnosis of Community-Acquired Pneumonia: Risk Factors and Outcomes From a 48 Hospital Cohort Study

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This study examined how often community-acquired pneumonia (CAP) is overdiagnosed in hospitalized adults, what predicts overdiagnosis, and whether unnecessary antibiotic treatment affects 30-day outcomes. Using a retrospective cohort of 17,438 patients treated for CAP across 48 hospitals (July 2018–March 2020), researchers defined overdiagnosis as receiving antibiotics and a pneumonia discharge diagnosis without meeting diagnostic criteria or having another infection.<br /><br />Overall, 12.4% of patients were overdiagnosed. Overdiagnosis was more common in older adults and in patients with dementia or altered mental status. Other factors associated with overdiagnosis included Hispanic or Black race, higher comorbidity burden, older age groups, COPD exacerbation, and diabetes. In contrast, chronic kidney disease, sepsis at admission, and CHF exacerbation were associated with lower odds of overdiagnosis.<br /><br />The study also evaluated harms linked to each additional day of unnecessary antibiotics. Longer antibiotic overuse was associated with a higher risk of patient-reported adverse events and a small increase in discharge to a skilled nursing facility in unadjusted analyses, but these associations were not significant after adjustment except for patient-reported adverse events. There was no adjusted association between antibiotic overuse and mortality, readmission, emergency department visits, Clostridioides difficile infection, physician-reported adverse events, or the composite outcome.<br /><br />The authors conclude that CAP overdiagnosis is common and concentrated in vulnerable groups, especially older adults and patients with cognitive or mental status impairment. While extended unnecessary antibiotic use was linked mainly to patient-reported adverse effects, the findings highlight the need for better diagnostic accuracy to reduce antibiotic overuse and improve patient safety.

Asset Subtitle

Valerie M. Vaughn

Meta Tag

Author List Ashwin B. Gupta, Jennifer K. Horowitz, Tanima Basu, Valerie M. Vaughn

Category Research

Concept Community-Acquired Pneumonia

Concept Overdiagnosis

Concept Antibiotic Overuse

Concept Hospitalized Adults

Concept Prevalence

Distinguished Non-Finalist

Presenter Organization University of Utah

Presenting Author Valerie M. Vaughn

Track Outcomes Research

Keywords

community-acquired pneumonia

CAP overdiagnosis

hospitalized adults

unnecessary antibiotics

retrospective cohort

diagnostic criteria

patient safety

older adults

altered mental status

adverse events

Community-Acquired Pneumonia

Overdiagnosis

Antibiotic Overuse

Hospitalized Adults

Prevalence