A new scoring system for Drug Resistance in Pneumonia (DRIP) has demonstrated efficacy in improving pneumonia-related prescription trends, including a significant drop in broad-spectrum antibiotic prescriptions. The results from this research was presented at IDWeek 2019, held October 2 to October 6, in Washington, DC.
This retrospective chart review included 89 individuals receiving pneumonia care at the Detroit Medical Center, 45 of whom received treatment before DRIP implementation and 44 who received treatment after. Demographics and clinical features of infection were compared, including severity of pneumonia as measured with the CURB-65 score, Charlson comorbidity index score, outcome measures, data on antibiotics, and symptomology. Both healthcare associated pneumonia (HCAP) risk factors and DRIP scores were calculated for all participants. The Detroit Medical Center’s guidelines for pneumonia treatment included antibiotic regimens selected for methicillin-resistant Staphylococcus aureus and/or nosocomial Gram-negative organisms; broad-spectrum antibiotics were defined in a manner consistent with these guidelines.
Among participants receiving treatment before DRIP implementation, 40% showed HCAP risk factors for antibiotic resistance; among the postimplementation group, 32% showed HCAP risk factors. In the preimplementation cohort, 33% had risk factors for resistance (DRIP ≥4), whereas 18% of the postimplementation showed risk factors. The prescription of broad-spectrum antibiotics to patients with a high risk for resistance/HCAP but a low DRIP risk (score <4) also decreased pre- and postimplementation (72% vs 16%). The preimplementation cohort had a 53% use of broad-spectrum antibiotics, compared with 27% after implementation (P =.03). Antibiotic duration was 8.3 days vs 9.8 days pre- and postimplementation, respectively (P =.04). There was a 7.5% rate of pneumonia readmission within 30 days in both groups.
Researchers concluded that implementing a new DRIP scoring system “resulted in improved prescribing patterns and a significant reduction of broad-spectrum antibiotics by 26% as compared [with] traditional HCAP score.”
Sandhu A, Goldman E, Polistico J, et al. Impact of utilizing drug resistance in pneumonia (DRIP) score on management of pneumonia. Poster presented at: IDWeek 2019; October 2-4, 2019; Washington, DC. Poster 1185.