印度尼西亚雅加达 Cipto Mangunkusumo 医院中，DRIP 评分预测社区获得性肺炎中耐药病原体感染的效力。

The Validation of Drug Resistance in Pneumonia (DRIP) Score in Predicting Infections due to Drug-Resistant Pathogens in Community-acquired Pneumonia at Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

机构信息

1. Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 2. Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Andalas University - M. Djamil Hospital, Padang, Indonesia.

出版信息

Acta Med Indones. 2021 Oct;53(4):416-422.

PMID:35027488

Abstract

BACKGROUND

The emergence of drug-resistant pathogens (DRP) in recent years possibly contributes to the common problems associated with community-acquired pneumonia. However, to predict the risk of the ailment, the DRIP score is mainly applied, although no validation study has been reported in Indonesia. Therefore, the score prediction accuracy in the population, patient characteristics and germ patterns appears indefinite, particularly for Cipto Mangunkusumo Hospital, Jakarta. The purpose of this study is to determine the DRIP performance as an instrument in predicting infections due to drug-resistant pathogens (DRP) in community-acquired pneumonia at Cipto Mangunkusumo Hospital.

METHODS

This research employed a cross-sectional design, where the subjects were community-acquired pneumonia patients treated between January 2019 and June 2020. In addition, adequate medical records of the participants were obtained. The condition is defined as DRP when the sputum culture results show resistance to non-pseudomonal β-lactam antibiotics, macrolides, and respiratory fluoroquinolones. Furthermore, the score performance was analyzed by determining the calibration and discrimination values, using the Hosmer-Lemeshow test and AUROC, respectively.

RESULTS

A total of 254 subjects were known to have satisfied the selection criteria. These participants were categorized into DRP and non-DRP groups, with 103 (40.6%) and 151 (59.4%) patients, correspondingly. The DRIP calibration analysis using the Hosmer-Lemeshow test obtained p-value = 0.001 (p <0.05), while an AUC value of 0.759 (CI 95%, 0.702-0.810) was derived from the ROC curve. However, at a score of ≥ 4, the DRIP showed sensitivity, specificity, positive and negative predictive values of 70.9, 92.7, 86.9, and 82.3%, respectively.

CONCLUSION

The DRIP score demonstrated a significant performance in predicting infections due to DRP in community-acquired pneumonia.

摘要

背景

近年来，耐药病原体（DRP）的出现可能导致与社区获得性肺炎相关的常见问题。然而，为了预测疾病的风险，主要应用 DRIP 评分，但在印度尼西亚尚未报告验证研究。因此，该评分在人群、患者特征和病菌模式方面的预测准确性尚不确定，特别是对于雅加达 Cipto Mangunkusumo 医院。本研究旨在确定 DRIP 评分作为预测 Cipto Mangunkusumo 医院社区获得性肺炎中耐药病原体（DRP）感染的工具的性能。

方法

本研究采用横断面设计，研究对象为 2019 年 1 月至 2020 年 6 月期间治疗的社区获得性肺炎患者。此外，还获得了参与者的充分医疗记录。当痰培养结果显示对非假单胞菌β-内酰胺类抗生素、大环内酯类和呼吸氟喹诺酮类药物耐药时，将该情况定义为 DRP。此外，通过 Hosmer-Lemeshow 检验和 AUROC 分别确定校准和判别值来分析评分性能。

结果

共有 254 名符合入选标准的患者。这些参与者被分为 DRP 和非 DRP 组，分别有 103 名（40.6%）和 151 名（59.4%）患者。使用 Hosmer-Lemeshow 检验进行 DRIP 校准分析时，p 值为 0.001（p<0.05），而 ROC 曲线得出 AUC 值为 0.759（95%CI，0.702-0.810）。然而，在评分≥4 时，DRIP 的敏感性、特异性、阳性和阴性预测值分别为 70.9%、92.7%、86.9%和 82.3%。