Validation of a scoring tool to predict drug-resistant pathogens in hospitalised pneumonia patients

• Published in: The international journal of tuberculosis and lung disease Vol. 17; no. 5; pp. 704 - 709
• Main Authors: Park, S. C., Kim, E. Y., Kang, Y. A., Park, M. S., Kim, Y. S., Kim, S. K., Chang, J., Jung, J. Y.
• Format: Journal Article
• Language: English
• Published: Paris, France International Union Against Tuberculosis and Lung Disease 01.05.2013; International Union against Tuberculosis and Lung Disease
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Area Under Curve; Bacterial diseases; Biological and medical sciences; Chi-Square Distribution; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - microbiology; Cross Infection - transmission; Decision Support Techniques; Drug Resistance, Bacterial; Female; Health Care; Human bacterial diseases; Humans; Infectious diseases; Inpatients; Logistic Models; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Mycobacterium; Pneumology; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - transmission; Prediction; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Risk Scoring; ROC Curve; Treatment Failure; Tuberculosis and atypical mycobacterial infections; Unnecessary Procedures; Human; Lung disease; Pneumonia; Treatment resistance; Respiratory disease; Prediction; Patient; Risk; Hospitalization; risk scoring; Care; Test validation; Pathogenic; Risk factor; Predictive factor; Public health; health care; Tool
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.12.0723

BACKGROUND: Health care-associated pneumonia (HCAP) affects a heterogeneous group of patients in frequent contact with health care systems. However, HCAP criteria poorly predict infection with drug-resistant (DR) pathogens.OBJECTIVE: To validate our previously reported risk-scoring model (predictive of DR pathogen infection) in patients admitted to hospital with pneumonia.DESIGN: We evaluated 580 patients admitted with culture-positive bacterial pneumonia. We identified risk factors, evaluated the risk-scoring model's capacity to predict infection by DR pathogens and compared the model's diagnostic accuracy with that of current HCAP criteria.RESULTS: DR pathogens were observed in 227/580 patients (39.1%). Of 269 HCAP patients, 153 (56.9%) were infected with DR pathogens. Overtreatment was more common in HCAP than in community-acquired pneumonia (58.7% vs. 41.2%, P < 0.001). Recent hospitalisation, admission from a long-term care facility, recent antibiotic treatment and tube feeding were independently associated with DR pathogens. For pathogen prediction, the risk-scoring model showed better diagnostic accuracy than HCAP criteria (area under receiver operating-characteristic curve = 0.723 vs. 0.673, P < 0.001).CONCLUSION: According to current HCAP criteria, half of the HCAP patients were treated unnecessarily with broad-spectrum antibiotics. Risk scoring by stratifying risk factors could improve the identification of patients likely to be infected with DR pathogens.