Format

Send to

Choose Destination
Antimicrob Agents Chemother. 2016 Apr 22;60(5):2652-63. doi: 10.1128/AAC.03071-15. Print 2016 May.

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

Author information

1
Intermountain Healthcare, Division of Epidemiology and Infectious Diseases, Salt Lake City, Utah, USA Brandon.Webb@imail.org.
2
Intermountain Healthcare, Division of Epidemiology and Infectious Diseases, Salt Lake City, Utah, USA.
3
Mayo Clinic in Arizona, Division of Infectious Diseases, Phoenix, Arizona, USA.
4
Mayo Clinic in Arizona, Division of Hospital Internal Medicine, Phoenix, Arizona, USA.
5
Mayo Clinic in Arizona, Division of Pulmonary Medicine, Phoenix, Arizona, USA.
6
Mayo Clinic in Arizona, Department of Internal Medicine, Scottsdale, Arizona, USA.
7
University of Connecticut Medical Center, Department of Internal Medicine, Farmington, Connecticut, USA.
8
University of Connecticut Medical Center, Division of Pulmonary and Critical Care Medicine, Farmington, Connecticut, USA.
9
Division of Pulmonary and Critical Care Medicine at Intermountain Medical Center and the University of Utah, Salt Lake City, Utah, USA.

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 derivation cohort of 200 microbiologically confirmed pneumonia cases in 2011 and 2012 was identified retrospectively. Risk factors for pneumonia due to drug-resistant pathogens were evaluated by logistic regression, and a novel prediction score (the drug resistance in pneumonia [DRIP] score) was derived. The score was then validated in a prospective, observational cohort of 200 microbiologically confirmed cases of pneumonia at four U.S. centers in 2013 and 2014. The DRIP score (area under the receiver operator curve [AUROC], 0.88 [95% confidence interval {CI}, 0.82 to 0.93]) performed significantly better (P = 0.02) than the HCAP criteria (AUROC, 0.72 [95% CI, 0.64 to 0.79]). At a threshold of ≥4 points, the DRIP score demonstrated a sensitivity of 0.82 (95% CI, 0.67 to 0.88), a specificity of 0.81 (95% CI, 0.73 to 0.87), a positive predictive value (PPV) of 0.68 (95% CI, 0.56 to 0.78), and a negative predictive value (NPV) of 0.90 (95% CI, 0.81 to 0.93). By comparison, the performance of HCAP criteria was less favorable: sensitivity was 0.79 (95% CI, 0.67 to 0.88), specificity was 0.65 (95% CI, 0.56 to 0.73), PPV was 0.53 (95% CI, 0.42 to 0.63), and NPV was 0.86 (95% CI, 0.77 to 0.92). The overall accuracy of the HCAP criteria was 69.5% (95% CI, 62.5 to 75.7%), whereas that of the DRIP score was 81.5% (95% CI, 74.2 to 85.6%) (P = 0.005). Unnecessary extended-spectrum antibiotics were recommended 46% less frequently by applying the DRIP score (25/200, 12.5%) than by use of HCAP criteria (47/200, 23.5%) (P = 0.004), without increasing the rate at which inadequate treatment recommendations were made. The DRIP score was more predictive of the risk of pneumonia due to drug-resistant pathogens than HCAP criteria and may have the potential to decrease antibiotic overutilization in patients with pneumonia. Validation in larger cohorts of patients with pneumonia due to all causes is necessary.

PMID:
26856838
PMCID:
PMC4862530
DOI:
10.1128/AAC.03071-15
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center