Guiding Broad-Spectrum Antibiotic Use in Pneumonia: DRIP vs HCAP Criteria

The electronically calculated Drug-Resistance in Pneumonia (DRIP) score had greater advantages in guiding appropriate broad-spectrum antibiotic use compared with the Healthcare Associated Pneumonia (HCAP) criteria in patients with community-onset pneumonia, according to a new study published in CHEST.

The DRIP score is a previously validated model that can be calculated in real time using an automated query of patients’ electronic health records. Scores from DRIP were integrated into an electronic clinical decision support tool for pneumonia (ePNa) that uses severity criteria to guide admission decisions and make antibiotic recommendations.

Patients admitted to the hospital from four different emergency departments with community-onset pneumonia were categorized by the DRIP score as being at low risk for drug-resistant bacteria (DRIP score <4) or at high risk for drug-resistant bacteria (DRIP ≥4). In patients at low and high risk, the ePNa recommends ceftriaxone plus azithromycin and an antipseudomonal beta-lactam plus vancomycin and azithromycin, respectively.

A total of 2169 adults admitted for pneumonia were included in the analysis. In 2012 and 2015, a drug-resistant pathogen was recovered in 3.2% and 2.8% of patients, respectively. Approximately 1.1% of patients in 2012 and 0.5% of patients in 2015 were prescribed inadequate initial empiric antibiotics.

A greater proportion of patients were prescribed broad-spectrum antibiotics in 2012 vs 2015 (40.1% vs 33.0%, respectively; P <.001). Additionally, a greater number of vancomycin therapy days per 1000 patient-days was recorded in 2012 compared with 2015 (287.3 vs 238.8 days, respectively; P <.001).

There was a reduction in broad-spectrum antibiotic use in patients scored with DRIP vs the HCAP criteria (odds ratio [OR], 0.62; 95% CI, 0.39-0.98; P =.039). There was no effect of DRIP on mortality (OR, 0.84; 95% CI, 0.43-1.6; P =.59), length of stay (OR, 0.98; 95% CI, 0.82-1.2; P =.81), or cost (OR, 0.93; 95% CI, 0.75-1.1; P =.47).

According to the researchers, a limitation of the study was confounding by indication.

“Further evaluation of DRIP in other [emergency departments] with varying patient demographics and resistance patterns is warranted,” the researchers added.

Disclosures: Dr Webb reports financial relationships with Astellas Pharma, Inc and BioFire Diagnostics.

Reference

Webb BJ, Sorensen J, Mecham I, et al. Antibiotic use and outcomes after implementation of the Drug Resistance in Pneumonia (DRIP) score in emergency department patients with community-onset pneumonia [published online May 8, 2019]. CHEST. doi:10.1016/j.chest.2019.04.093

This article originally appeared on Pulmonology Advisor