Factors influencing microbial diagnostic testing for infectious diseases in Korea: a nationwide retrospective cohort study
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Background: Diagnostic tests are essential for accurate disease identification and monitoring treatment responses. This study aimed to assess the factors influencing the requests for microbial diagnostic tests in patients with various infections. Methods: Using tailored data from the National Health Insurance Big Data, we examined the usage patterns of microbiological tests among patients with pulmonary tuberculosis (TB) and major bacterial infections between 2020 and 2022, excluding overlapping and complex infections (n = 8,268,992). The types of bacterial infections included pneumonia, sepsis, urinary tract infections, and soft tissue infections, for which bacterial culture and antimicrobial susceptibility tests were performed. For pulmonary TB cases, acid-fast bacillus smears, mycobacterial cultures, and molecular diagnostic tests were performed. Multivariate analysis was used to identify the factors influencing the prescription of microbiological diagnostic tests, considering variables such as age, sex, Charlson comorbidity index, underlying disease, type of medical institution, residential area, insurance quintile, and disability status. Results: Requests for TB-related and bacterial infection-related tests varied according to multiple factors, including sex, age, insurance quintile, residential area, presence or absence of disability, disease severity, type of medical institution admission, chemotherapy, steroid use, comorbid conditions, and underlying diseases. Conclusions: This study is considered to be rare data analyzed using large-scale national data on various factors affecting test prescriptions, which could provide useful data for improving policies for appropriate test prescriptions.
Abstract
Background: Diagnostic tests are essential for accurate disease identification and monitoring treatment responses. This study aimed to assess the factors influencing the requests for microbial diagnostic tests in patients with various infections. Methods: Using tailored data from the National Health Insurance Big Data, we examined the usage patterns of microbiological tests among patients with pulmonary tuberculosis (TB) and major bacterial infections between 2020 and 2022, excluding overlapping and complex infections (n = 8,268,992). The types of bacterial infections included pneumonia, sepsis, urinary tract infections, and soft tissue infections, for which bacterial culture and antimicrobial susceptibility tests were performed. For pulmonary TB cases, acid-fast bacillus smears, mycobacterial cultures, and molecular diagnostic tests were performed. Multivariate analysis was used to identify the factors influencing the prescription of microbiological diagnostic tests, considering variables such as age, sex, Charlson comorbidity index, underlying disease, type of medical institution, residential area, insurance quintile, and disability status. Results: Requests for TB-related and bacterial infection-related tests varied according to multiple factors, including sex, age, insurance quintile, residential area, presence or absence of disability, disease severity, type of medical institution admission, chemotherapy, steroid use, comorbid conditions, and underlying diseases. Conclusions: This study is considered to be rare data analyzed using large-scale national data on various factors affecting test prescriptions, which could provide useful data for improving policies for appropriate test prescriptions.