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Pneumonia misdiagnoses are common among hospitalized adults, study finds: There are ‘implications’

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Adults who are admitted to the hospital are often inappropriately diagnosed with — and treated for — pneumonia, new research suggests.

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

Among older adults who were treated for community-acquired pneumonia in the hospital, 12% were misdiagnosed, researchers found.

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

The Centers for Disease Control and Prevention (CDC) estimates that about 47 million courses of antibiotics are prescribed annually in the U.S. for infections that don’t require that course of action.

Older woman in hospital

Among older adults who were treated for community-acquired pneumonia in the hospital, 12% were misdiagnosed, researchers found. (iStock)

Overuse of antibiotics can lead to resistance, meaning that the bacteria becomes strong enough to withstand the medication. 

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

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

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

Main types of pneumonia

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

Community-acquired pneumonia (CAP) describes a type of pneumonia in a patient who has not recently been hospitalized.

In these scenarios, patients acquire the lung infection while in a community setting, according to the National Institutes of Health (NIH). 

Man taking medicine

Overuse of antibiotics can lead to resistance, meaning the bacteria becomes strong enough to withstand the medication.  (iStock)

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

They don’t have the infection when they’re first admitted, but acquire it later after being exposed to bacteria in the hospital setting.

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

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Certain individuals with CAP, however, may require hospitalization if they have serious medical problems, severe symptoms, are unable to eat or drink, are over age 65, or are taking antibiotics but not improving, the NIH noted.

CAP is one of the most common causes of hospitalization in the U.S., according to the CDC.

What the study found

Researchers at the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan Medical School – led by lead researcher Ashwin B. Gupta, M.D., clinical associate professor at the University of Michigan Health – examined patient records from the Michigan Hospital Medicine Safety Consortium, an initiative to improve the hospitalized care of patients.

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.

They analyzed approximately 17,000 adults who were hospitalized between July 1, 2017, and March 31, 2020, at 48 hospitals in Michigan.

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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.

Participants were considered “inappropriately diagnosed” if they had fewer than two symptoms of pneumonia or if their chest X-rays tested negative for the infection. (In other words, if they got the diagnosis but didn’t have two symptoms or positive X-rays, the diagnosis was wrong.)

Woman in hospital

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. (iStock)

The study found that an inappropriate diagnosis of community-acquired pneumonia among hospitalized patients is common – especially among certain groups, such as older adults or those with dementia and altered mental status.

Those who were inappropriately diagnosed almost always received a full course of antibiotics, the researchers noted.

Common symptoms

A classic diagnosis of pneumonia involves typical symptoms — such as cough, fever, chills and shortness of breath — combined with radiographic evidence on a chest X-ray, according to experts.

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

“When you present to the hospital with cough or shortness of breath, for example, the list of potential etiologies is quite broad,” lead researcher Gupta told Fox News Digital via email.

Doctor with woman

A classic diagnosis of pneumonia involves typical symptoms — such as cough, fever, chills and shortness of breath — combined with radiographic evidence on a chest X-ray. (iStock)

“We found that often, those who likely have an underlying non-pneumonia etiology (e.g., congestive heart failure) are being classified as having pneumonia and are treated as such,” he continued.

“Inappropriate diagnosis and treatment of pneumonia may have implications, such as delays in understanding the actual problem or adverse effects related to antibiotic treatment.”

Dangers of unnecessary antibiotics

“Inappropriate diagnosis is not benign,” the lead researcher warned. 

“It means that the understanding of the underlying cause of a patient’s illness may be delayed or missed altogether.”

He added, “Antibiotic therapy is not benign, either — our study demonstrated that full durations of antibiotic therapy in this population are associated with antibiotic-associated 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.

“I think the study is alarming in that many patients (one out of eight, or over 10%) are receiving inappropriate diagnoses of pneumonia and being given full treatment courses,” Dr. Scott Roberts, associate medical director of infection prevention at Yale School of Medicine in New Haven, Connecticut, told Fox News Digital. 

He was not involved in the study. 

Taking antibiotics

Common side effects of antibiotic use include an itchy, full-body rash; nausea and diarrhea; and yeast infections, according to the CDC. (iStock)

“This is especially problematic because the patient population where this is occurring are the ones most at risk for the adverse events associated with antibiotic use.”

Roberts emphasized the need for providers to diagnose conditions accurately before subjecting patients to full courses of antibiotics, which may be unnecessary and could lead to adverse side effects.

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

Serious 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.

Emergency room

A doctor emphasized the need for providers to diagnose conditions accurately before subjecting patients to full courses of antibiotics. (iStock)

“Diagnosis is challenging, and by and large, providers are trying to best care for their patients,” Gupta noted.

“We often think about problems related to underdiagnosis of conditions (e.g., missed infection), though there are real risks to inappropriate diagnosis as well,” he said. 

Study limitations

The researchers likely underestimated the number of patients who were inappropriately diagnosed, as the signs and symptoms of pneumonia have significant overlap with other conditions, the researchers noted.

The study was also not designed to assess “causation,” Gupta pointed out.

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“So, while we can say that there is an association between a full duration of antibiotics and antibiotic-associated adverse events, we cannot say that a full duration of antibiotics caused the antibiotic-associated adverse events,” he continued.

He said he hoped that “this work will provide a framework on which providers, hospitals and health systems can calibrate the accuracy of their pneumonia diagnoses among hospitalized patients.”

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Magnitude 2.8 earthquake reported in View Park-Windsor Hills

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A magnitude 2.8 earthquake was reported Tuesday at 8:19 a.m. Pacific time in Los Angeles’ View Park-Windsor Hills neighborhood, according to the U.S. Geological Survey.

The earthquake‘s epicenter was 7.1 miles beneath the intersection of Overland Drive and Northridge Drive, near Windsor Hills Elementary School. .

In the last 10 days, there have been no earthquakes of magnitude 3.0 or greater centered nearby.

An average of 59 earthquakes with magnitudes between 2.0 and 3.0 occur per year in the Greater Los Angeles area, according to a recent three-year data sample.

Did you feel this earthquake? Consider reporting what you felt to the USGS.

Are you ready for when the Big One hits? Get ready for the next big earthquake by signing up for our Unshaken newsletter, which breaks down emergency preparedness into bite-sized steps over six weeks. Learn more about earthquake kits, which apps you need, Lucy Jones’ most important advice and more at latimes.com/Unshaken.

This story was automatically generated by Quakebot, a computer application that monitors the latest earthquakes detected by the USGS. A Times editor reviewed the post before it was published. If you’re interested in learning more about the system, visit our list of frequently asked questions.



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Justice Thomas returns to Supreme Court after 1-day absence

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WASHINGTON (AP) — Supreme Court Justice Clarence Thomas is back on the bench after an unexplained one-day absence.

Thomas, 75, was in his usual seat, to the right of Chief Justice John Roberts as the court met to hear arguments in a case about the Capitol riot on Jan. 6, 2021.

Thomas has ignored calls from some progressive groups to step aside from cases involving Jan. 6 because his wife, Ginni, attended then-President Donald Trump‘s rally near the White House before protesters descended on the Capitol. Ginni Thomas, a conservative activist, also texted senior Trump administration officials in the weeks after the election offering support and reiterating her belief that there was widespread fraud in the election.

On Monday, Roberts announced Thomas’ absence, without providing an explanation. Justices sometimes miss court, but participate remotely. Thomas did not take part in Monday’s arguments.

He was hospitalized two years ago with an infection, causing him to miss several court sessions. He took part in the cases then, too.

Thomas is the longest serving of the current justices, joining the Supreme Court in 1991.



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Germany’s Leader, Olaf Scholz, Walks a Fine Line in China

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Chancellor Olaf Scholz of Germany tried to strike a delicate balance on a trip to China this week, promoting business ties with his country’s biggest trading partner while criticizing its surge of exports to Europe and its support for Russia.

Mr. Scholz met with China’s top leader, Xi Jinping, at the Diaoyutai State Guesthouse in Beijing on Tuesday, the culmination of a three-day visit with a delegation of German officials and business leaders. He was also expected to meet with Premier Li Qiang, as the two countries navigate relations strained by Russia’s war in Ukraine and China’s rivalry with the United States, Germany’s most important ally.

Throughout his trip, Mr. Scholz promoted the interests of German companies that are finding it increasingly hard to compete in China. And he conveyed growing concern in the European Union that the region’s market is becoming a dumping ground for Chinese goods produced at a loss.

It was Mr. Scholz’s first visit to China since his government adopted a strategy last year that defined the Asian power as a “partner, competitor and systemic rival,” calling on Germany to reduce its dependency on Chinese goods.

Germany’s economy shrank last year, and its weaknesses have exposed a reliance on China for growth. Energy prices have risen because of the war in Ukraine, which has been facilitated by Beijing’s support for the Kremlin. German companies have pushed for more access to China and complained that they face unfair competition.

During his trip, which began in the sprawling industrial metropolis of Chongqing in China’s southwest and continued in Shanghai and Beijing, the chancellor visited German companies with extensive investments in China, met with trade representatives and talked with university students.

“Competition must be fair,” Mr. Scholz told a group of German-speaking students in Shanghai on Monday. “We want a level playing field,” he said.

Mr. Scholz’s trip was an example of the difficult dance that Germany is trying to do: maintaining economic ties with China while managing U.S. pressure to align itself more closely with Washington against Beijing. He was also expected to convey European leaders’ geopolitical and trade concerns to China.

In his meetings, Mr. Scholz highlighted Germany’s commitment to doing business with China, but he also warned that Beijing had to curb the flood of Chinese goods into Europe. At the same time, he expressed reservations about the European Union’s investigations into China’s use of subsidies for green technology industries, saying that any discussion about trade must be based on fairness.

“This must be done from a position of self-confident competitiveness and not from protectionist motives,” Mr. Scholz told reporters on Monday.

China’s manufacturing push in green sectors like electric cars and solar panels has touched off trade disputes with Europe and the United States, where such industries have also received government support. But with 5,000 German companies active in the Chinese market, Germany stands to lose more than many of its European partners would if Beijing were to retaliate against the European Union.

“If the E.U. goes too hard against China, we could expect countermeasures and this would be a catastrophe for us,” said Maximilian Butek, the executive director of the German Chamber of Commerce in China.

“For us it’s extremely important that the Chinese market remains open,” he said.

In his meetings with Chinese leaders, Mr. Scholz was also expected to raise concerns about Beijing’s support of Moscow’s wartime economy, especially its continued sale to Russia of goods with potential uses on the battlefield.

In his discussion with students in Shanghai, Mr. Scholz alluded to Russia’s war in Ukraine, saying that the world functioned best when all nations embraced some basic shared principles.

“One of these is that one should not have to fear its neighbors,” Mr. Scholz said, without naming any nations. “Borders cannot be changed with force.”

China is hoping to drive a wedge between Europe and the United States by courting leaders such as Mr. Scholz. State media reports depicted his visit as demonstrating the strength of China’s relations with Europe, playing up its economic ties with Germany.

Beijing is sure to welcome the message that German businesses are committed to China. The Asian giant is trying to court foreign investment to reinvigorate its economy, which has faltered because of a housing slowdown. Some Western businesses and investors have also been rattled by Mr. Xi’s emphasis on national security, which they regard as making it riskier to operate in the country.

From China’s perspective, Germany may be its best hope of delaying or watering down any trade restrictions from Europe, said Noah Barkin, a senior adviser in the China practice at the Rhodium Group, a research firm.

German carmakers have invested billions of dollars in China, and much of their revenue comes from there. Many worry that if the European Commission imposes higher tariffs on Chinese exports, and Beijing retaliates, German businesses will suffer most.

Chinese officials “know that German companies are heavily invested and they use that politically to influence political decision making in Berlin,” Mr. Barkin said.

Germany’s biggest companies, including BMW, Mercedes-Benz and BASF, are heavily invested in China and have strong, effective lobbies in Berlin, Mr. Barkin added. Executives from those companies, along with several others, traveled with Mr. Scholz to China.

“The supply chain in China is stuffed with German goods,” said Joerg Wuttke, a former president of the E.U. Chamber of Commerce in China. “If China has a price war with Germany, than no one will make money anymore.”

Chinese officials, for their part, have brushed off the European accusations of unfair trading practices, calling them groundless and an act of “typical protectionism.” They have hinted that they could retaliate for any actions taken by the E.U., saying that China was “strongly dissatisfied with and firmly opposes” its investigations.

Wang Wentao, China’s commerce minister, went to Europe last week to show Beijing’s support for Chinese companies and push back against the accusations that China was dumping goods on the region and posing a risk to global markets.

In an interview with the German newspaper Handelsblatt, Wu Ken, China’s ambassador to Germany, said the competitive of Chinese electric vehicles “relies on innovation, not subsidies.”

“The challenge faced by developed countries lies more in the fact that Chinese companies are more efficient,” the ambassador said.

Zixu Wang contributed reporting from Hong Kong.



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