Department of Pharmacy, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
Department of Pharmacy Services, University of Utah Health, Salt Lake City, Utah, USA.
Antimicrob Agents Chemother. 2021 Jan 20;65(2). doi: 10.1128/AAC.01482-20.
The 2019 American Thoracic Society and the Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend that drug-resistant pathogens (DRP) be empirically covered if locally validated risk factors are present. This retrospective case-control validation study evaluated the performance of the drug resistance in pneumonia (DRIP) clinical prediction score. Two hundred seventeen adult patients with ICD-10 (https://www.who.int/classifications/classification-of-diseases) pneumonia diagnosis, positive confirmed microbiologic data, and clinical signs and symptoms were included. A DRIP score of ≥4 was used to assess model performance. Logistic regression was used to select for significant predictors and create a modified DRIP score, which was evaluated to define clinical application. The DRIP score predicted pneumonia due to a DRP with a sensitivity of 67% and specificity of 73%. The area under the receiver operating characteristic (AUROC) curve was 0.76 (95% confidence interval [CI], 0.69 to 0.82). From regression analysis, prior infection with a DRP and antibiotics in the last 60 days, yielding scores of 2 points and 1 point, respectively, remained local risk factors in predicting drug-resistant pneumonia. Sensitivity (47%) and specificity (94%) were maximized at a threshold of ≥2 in the modified DRIP model. Therefore, prior infection with a DRP remained the only clinically relevant predictor for drug-resistant pneumonia. The original DRIP score demonstrated a decreased performance in our patient population and behaved similarly to other clinical prediction models. Empiric CAP therapy without anti-methicillin-resistant and antipseudomonal coverage should be considered for noncritically ill patients without a drug resistant pathogen infection in the past year. Our data support the necessity of local validation to authenticate clinical risk predictors for drug-resistant pneumonia.
2019 年美国胸科学会和美国传染病学会社区获得性肺炎（CAP）指南建议，如果存在当地验证的风险因素，则应经验性覆盖耐药病原体（DRP）。本回顾性病例对照验证研究评估了肺炎耐药性指数（DRIP）临床预测评分的性能。纳入了 217 名患有 ICD-10（https://www.who.int/classifications/classification-of-diseases）肺炎诊断、阳性确诊微生物学数据以及临床症状和体征的成年患者。使用 DRIP 评分≥4 来评估模型性能。使用逻辑回归选择显著预测因子并创建改良的 DRIP 评分，并评估其临床应用。DRIP 评分预测 DRP 引起的肺炎的敏感性为 67%，特异性为 73%。受试者工作特征（ROC）曲线下面积（AUROC）为 0.76（95%置信区间[CI]，0.69 至 0.82）。从回归分析来看，先前感染 DRP 和过去 60 天内使用抗生素分别为 2 分和 1 分，仍然是预测耐药性肺炎的局部风险因素。在改良的 DRIP 模型中，阈值为≥2 时，敏感性（47%）和特异性（94%）最高。因此，先前感染 DRP 仍然是耐药性肺炎的唯一具有临床相关性的预测因子。原始的 DRIP 评分在我们的患者人群中表现不佳，行为与其他临床预测模型相似。对于过去一年没有耐药病原体感染的非危重症患者，应考虑 CAP 经验性治疗，无需覆盖耐甲氧西林金黄色葡萄球菌和抗假单胞菌。我们的数据支持对耐药性肺炎的临床风险预测因子进行本地验证的必要性。
