Hospitalized adults often experience misdiagnoses of pneumonia, according to a study, which has 'implications' for patient care.

New research suggests that adults who are admitted to the hospital are frequently misdiagnosed with and treated for pneumonia.

Almost always, adults who are misdiagnosed receive a full course of antibiotics that may not be necessary, according to a new study in JAMA Internal Medicine.

Researchers discovered that 12% of older adults who received treatment for community-acquired pneumonia in the hospital were misdiagnosed.

The study found that 88% of patients who were misdiagnosed received a full antibiotic treatment course, with 2% experiencing adverse side effects from the medication.

Approximately 47 million antibiotic prescriptions are given in the U.S. each year for infections that don't necessitate such treatment.

Overuse of antibiotics can result in resistance, where bacteria become resistant to the medication.

Each year, over 23,000 deaths occur in the U.S. due to antibiotic resistance, per the CDC.

This can limit the treatment options available to doctors and make it more difficult for them to cure infections.

According to the CDC, each year in the U.S., approximately 23,000 deaths result from antibiotic resistance.

Main types of pneumonia

There are two primary types of pneumonia: community-acquired and hospital-acquired.

A patient with community-acquired pneumonia (CAP) has not recently been hospitalized.

According to the National Institutes of Health (NIH), patients contract the lung infection while in a community setting.

Hospital-acquired pneumonia occurs after patients are admitted to the hospital.

Initially, they do not have the infection upon admission, but they contract it later due to exposure to bacteria in the hospital environment.

Many patients with community-acquired pneumonia are treated without needing to be hospitalized.

Individuals with CAP who have serious medical problems, severe symptoms, are unable to eat or drink, are over age 65, or are taking antibiotics but not improving may require hospitalization, the NIH stated.

According to the CDC, hospitalization in the U.S. is frequently caused by CAP.

What the study found

The study, led by Dr. Ashwin B. Gupta of the University of Michigan Health, examined patient records from the Michigan Hospital Medicine Safety Consortium to improve hospitalized care.

Patients in the study were admitted to the hospital for general care and later were diagnosed with pneumonia and were treated with antibiotics on the first or second day of admission.

In a study, researchers examined about 17,000 adults who were admitted to 48 Michigan hospitals between July 1, 2017, and March 31, 2020.

Patients in the study were initially admitted to the hospital for general care and later diagnosed with pneumonia, prompting them to receive antibiotics on the first or second day of admission.

If participants had fewer than two symptoms of pneumonia or negative chest X-rays, their diagnosis of pneumonia was deemed inappropriate.

Hospitalized patients are frequently misdiagnosed with community-acquired pneumonia, particularly those who are older or have dementia and altered mental status.

Almost always, those who were inappropriately diagnosed received a full course of antibiotics, the researchers observed.

Common symptoms

Experts say that a typical diagnosis of pneumonia requires the presence of symptoms such as cough, fever, chills, and shortness of breath, along with radiographic evidence on a chest X-ray.

The X-ray is necessary because many symptoms can overlap with other conditions.

The list of potential causes for cough or shortness of breath when presented to a hospital is extensive, according to lead researcher Gupta, as stated in an email to Planet Chronicle Digital.

Those with underlying non-pneumonia conditions, such as congestive heart failure, are frequently misclassified as having pneumonia and receive treatment accordingly.

"The misdiagnosis and treatment of pneumonia could lead to consequences, including a delay in identifying the true issue or negative effects from antibiotic therapy."

Dangers of unnecessary antibiotics

"Inappropriate diagnosis is not benign," the lead researcher warned.

"The comprehension of the root cause of a patient's ailment may be postponed or overlooked entirely."

Our study showed that full durations of antibiotic therapy in this population are linked to antibiotic-related adverse events.

"Inappropriate diagnosis … means the underlying cause of a patient’s illness may be delayed or missed altogether."

Outside experts also warned of the risk.

Dr. Scott Roberts, associate medical director of infection prevention at Yale School of Medicine in New Haven, Connecticut, stated to Planet Chronicle Digital that the study is concerning as it reveals that one out of eight patients, or over 10%, are being misdiagnosed with pneumonia and receiving full treatment courses.

He was not involved in the study.

"The problem is exacerbated because the patient group where this is happening are the ones who are most susceptible to the negative effects of antibiotic use."

It is crucial for providers to accurately diagnose conditions before prescribing full courses of antibiotics, which may be unnecessary and could result in adverse side effects, as emphasized by Roberts.

According to the CDC, common side effects of antibiotics include an itchy, full-body rash; nausea and diarrhea; and yeast infections.

Severe side effects may include life-threatening allergic reactions and a bacterial infection called C. diff (Clostridioides difficile), which can lead to severe colon damage and sometimes death.

Gupta observed that providing the best care for patients is challenging for healthcare providers.

Though there are risks associated with inappropriate diagnosis, we often focus on the issue of underdiagnosis of conditions, such as missed infections.

Study limitations

The researchers likely underestimated the number of patients who were inappropriately diagnosed due to the overlap of pneumonia's signs and symptoms with other conditions, the researchers noted.

Gupta pointed out that the study was not designed to evaluate causation.

Although we can establish a link between a complete course of antibiotics and adverse events related to antibiotics, we cannot definitively claim that the full duration of antibiotics caused these adverse events.

He expressed the hope that this work would serve as a basis for hospitals, providers, and health systems to fine-tune the precision of their pneumonia diagnoses among hospitalized patients.

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