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PLoS One. 2015 Apr 10;10(4):e0119528. doi: 10.1371/journal.pone.0119528. eCollection 2015.

Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia.

Author information

1
Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy; Department of Emergency Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
2
Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
3
Unit of Infectious Diseases, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
4
Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
5
Department of Emergency Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
6
Department of Microbiology, General Hospital, Ciudad Real, Spain.
7
Department of Clinical Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
8
Department of Public Health and Infectious Diseases-Statistics Section, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
9
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Abstract

INTRODUCTION:

The diffusion of multidrug-resistant (MDR) bacteria has created the need to identify risk factors for acquiring resistant pathogens in patients living in the community.

OBJECTIVE:

To analyze clinical features of patients with community-onset pneumonia due to MDR pathogens, to evaluate performance of existing scoring tools and to develop a bedside risk score for an early identification of these patients in the Emergency Department.

PATIENTS AND METHODS:

This was an open, observational, prospective study of consecutive patients with pneumonia, coming from the community, from January 2011 to January 2013. The new score was validated on an external cohort of 929 patients with pneumonia admitted in internal medicine departments participating at a multicenter prospective study in Spain.

RESULTS:

A total of 900 patients were included in the study. The final logistic regression model consisted of four variables: 1) one risk factor for HCAP, 2) bilateral pulmonary infiltration, 3) the presence of pleural effusion, and 4) the severity of respiratory impairment calculated by use of PaO2/FiO2 ratio. A new risk score, the ARUC score, was developed; compared to Aliberti, Shorr, and Shindo scores, this point score system has a good discrimination performance (AUC 0.76, 95% CI 0.71-0.82) and calibration (Hosmer-Lemeshow, χ2 = 7.64; p = 0.469). The new score outperformed HCAP definition in predicting etiology due to MDR organism. The performance of this bedside score was confirmed in the validation cohort (AUC 0.68, 95% CI 0.60-0.77).

CONCLUSION:

Physicians working in ED should adopt simple risk scores, like ARUC score, to select the most appropriate antibiotic regimens. This individualized approach may help clinicians to identify those patients who need an empirical broad-spectrum antibiotic therapy.

PMID:
25860142
PMCID:
PMC4393134
DOI:
10.1371/journal.pone.0119528
[Indexed for MEDLINE]
Free PMC Article

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