Derivation and Multicenter Validation of the Drug Resistance in Pneumonia Clinical Prediction Score

Abstract

The health care-associated pneumonia (HCAP) criteria have a limited ability to predict pneumonia caused by drug-resistant bacteria and favor the overutilization of broad-spectrum antibiotics. We aimed to derive and validate a clinical prediction score with an improved ability to predict the risk of pneumonia due to drug-resistant pathogens compared to that of HCAP criteria.

A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug‐Resistant Pneumonia in Critically Ill Adults: The DEFINE Study

“…Using the variables identified in this analysis, a constructed predictive model demonstrated 99.1% specificity and 15.1% sensitivity, with a false‐positive rate of 26.3% and false‐negative rate of 12.3% and an area under the receiver operator curve of 0.732. Comparatively, this predictive model had lower sensitivity and poor predictive value in relation to other predictive models for MDRO pneumonia . This may, in part, be explained by the sample size, number of variables analyzed, and definition of MDRO.…”

“…Comparatively, this predictive model had lower sensitivity and poor predictive value in relation to other predictive models for MDRO pneumonia. 7,19,20 This may, in part, be explained by the sample size, number of variables analyzed, and definition of MDRO.…”

The First Case of <i>Pseudomonas aeruginosa</i> Bacteremic Pneumonia in a Cancer Patient Receiving Pegfilgrastim

“…Several studies have proposed various predictive risk factors and prediction scores for MDR pathogens ( 17 - 21 ). In a previous study, in which clinical prediction scores were derived and validated, the drug resistance in pneumonia (DRIP) score was a better predictor of the risk of pneumonia due to MDR pathogens than the HCAP criteria (the ATS/IDSA guidelines) (DRIP vs. the HCAP criteria: area under the receiver operator curve [AUROC], 0.88 [95% confidence interval (CI): 0.82-0.93] vs. 0.72 [95% CI: 0.64-0.79]) ( 17 ). The patient in the present case was diagnosed with HCAP, had no risk factors for MDR pathogens (according to the ATS/IDSA guidelines), and his DRIP score indicated that he did not have a high risk of infection with MDR pathogens.…”

Health care–associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes

“…Research of risk factors for potentially drug-resistant pathogens has highlighted the suboptimal predictive ability of the HCAP criteria [31,32,34,35]. Several risk scores have been developed that perform better than the HCAP criteria in selecting resistant pathogens [8,10,35,36], and risk score strategies that separate out MRSA from other MDR organisms might prove to be useful [10,29,30]. Some have demonstrated that severity of illness might be used to help predict pneumonia pathogens [7,8,33]; however, this is not supported by all published studies [10].…”