Electronic prediction score more effective for guiding antibiotic therapy in pneumonia

When compared with health care-associated pneumonia criteria, electronic calculation of a prediction score more accurately predicted the risk for drug-resistant pathogens in patients with community-acquired pneumonia, new data published in Chest suggest.

In 2015, the researchers integrated the Drug Resistance in Pneumonia (DRIP) score — a novel, validated tool that predicts the presence of drug resistance — into an electronic clinical decision support tool for pneumonia introduced in 2011. They then compared the impact of adding DRIP vs. health care-associated pneumonia criteria to the electronic decision tool on broad-spectrum antibiotic use, mortality, hospital stay and costs.

Of 2,169 adults admitted to the ED at four hospitals, 1,122 were admitted in 2012 — prior to DRIP implantation — and 1,047 were admitted in 2015. In 2012, 3.2% of patients had drug-resistant pathogens and 1.1% were prescribed inadequate initial empiric antibiotics. This finding was not significantly different from the 2.8% of patients who had drug-resistant pathogens and the 0.5% who were prescribed inadequate initial empiric antibiotics in 2015 (P = .12).

From 2012 to 2015, there was a 7.2% (95% CI, 3.1-11.2) reduction in absolute risk in administration of broad-spectrum antibiotics (40.1% vs. 33%; P < .001) as well as a reduction in the number of days of vancomycin therapy (287.3 per 1,000 patient-days vs. 238.8 per 1,000 patient-days; P < .001).

The researchers reported that the average treatment effect in the DRIP group was a reduction in use of broad-spectrum antibiotics (OR = 0.62; 95% CI, 0.39-0.98), but there were no significant differences in the average effects of DRIP on mortality (OR = 0.84; 95% CI, 0.43-1.6), length of stay (OR = 0.98; 95% CI, 0.82-1.2) and cost (OR = 0.93; 95% CI, 0.75-1.1).

“Compared to [health care-associated pneumonia] criteria, the DRIP score is a more effective tool to assist clinicians in accurately identifying the risk of drug-resistant pathogens in pneumonia. Nevertheless, significant opportunities for improvement remain to reduce unnecessary antibiotic use in pneumonia,” the researchers wrote. “We plan to re-examine broad-spectrum antibiotic use in the same four EDs 3 years after DRIP deployment, hypothesizing that further reductions will be detected after both the DRIP score and MRSA nasal swab strategies are more familiar to clinicians. Further evaluation of DRIP in other EDs with varying patient demographics and resistance patterns is warranted.” – by Melissa Foster

Disclosures: Webb reports research support from Astellas Pharma unrelated to this study and speaking honorarium on pneumonia diagnostics from BioFire Diagnostics. Please see the study for all other authors’ relevant financial disclosures