Validation of a scoring tool to predict drug-resistant pathogens in hospitalised pneumonia patients

Abstract

According to current HCAP criteria, half of the HCAP patients were treated unnecessarily with broad-spectrum antibiotics. Risk scoring by stratifying risk factors could improve the identification of patients likely to be infected with DR pathogens.

Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumonia Developed Out of Hospital

“…Until now, the identified risk factors for drug-resistant pathogens were weighted differently, so risk stratification scoring tools showed better predictions of infection by drug-resistant pathogens than the current HCAP criteria [34,35]. Consistent with previous reports, our risk stratification model based on differently weighted predictors is more accurate than the presence of the identified risk factors or the HCAP criteria for assessing the probability of PDR pathogens.…”

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

“…active wound care at the time of admission (31,48), infusion therapy (chemotherapy or treatment with antibiotics or other intravenous medications) (29), poor functional status (defined as a Karnofsky score of Ͻ70 or nonambulatory status) (3,28,32,47), aspiration risk (17), diabetes mellitus (29,40), current smoking (39), severity of pneumonia (defined in three different ways: intensive care unit [ICU] admission, mechanical ventilator support, and predicted percent 30 day all-cause mortality using the electronic adaptation of the CURB-65 [eCURB] score [49]) (29,30,33,40), cerebrovascular disease (40,44), cognitive impairment (40,42), prior colonization with a DRP or MRSA strain (16,29,32,50,51), gastric acid suppression (with histamine H2 antagonists or proton pump inhibitors) within 14 days (32), and the presence of an indwelling catheter (47). In order to evaluate the temporal association with certain exposures, we collected quantitative data on the time from the previous hospitalization, nursing home residence, and antibiotic use, all within the last 180 days.…”

“…Ultimately, the optimum test performance was achieved by use of a hybrid cumulative and probabilistic model, built by including four major risk factors identified by regression analysis, weighted at two points each, plus a broad set of minor risk factors weighted equally at one point each. The HCAP criteria and six other previously described prediction models (the Park [31], Shindo [32], Shorr [33], Schreiber [38], Aliberti [44], and Niederman[54] models) were applied to the derivation cohort, and test performance characteristics were compared to the novel prediction score.…”

“…After reviewing the available literature, the following risk factors for pneumonia due to DRPs were identified and included in the data collection: prior antibiotic use (3,16,28,29,31,32,(37)(38)(39)(40)(41)(42), prior hospitalization (an inpatient stay of more than 48 h) (16, 31-33, 37, 39-41, 43-46), residence in a long-term-care facility (including facilities providing long-term acute care and facilities providing skilled nursing care and inpatient rehabilitation but not assisted living or group home facilities) (16,29,31,33,37,38,40,44,45,47), tube feeding (nasogastric/jejunal feeding or feeding via a percutaneous gastrostomy tube) (3,31,32,41), chronic lung disease (defined as chronic obstructive, interstitial, or other structural disease, including bronchiectasis but excluding cystic fibrosis) (17,29,31,38,39,42,44,45), immunosuppression (by daily treatment with systemic corticosteroids consisting of Ն15 mg prednisone; with immunomodulating agents, such as calcineurin inhibitors and mycophenolic acid, or with biologic agents, such as rituximab and tumor necrosis factor inhibitors, or because of heritable immunodeficiency, such as common variable immune deficiency; active hematologic or myeloproliferative malignancy; neutropenia [absolute neutrophil count, Ͻ1,000 cells/l]; or a CD4 count of Ͻ200 cells/l in patients with HIV infection or AIDS) (31,32,…”

“…Although several alternative predictive scores have been proposed (27)(28)(29)(30)(31)(32)(33), none has demonstrated sig-nificantly improved specificity compared to that of the HCAP criteria (34) and few validation studies with U.S. populations have been performed. Here we describe the derivation of the drug resistance in pneumonia (DRIP) score, a novel model to predict the risk of pneumonia due to DRPs, and the results of a prospective validation in a multicenter U.S. cohort.…”