By Ethan Covey
The prevalence of drug-resistant pathogens (DRPs) in a patient population may be underestimated when calculated using the drug resistance in pneumonia (DRIP) score, according to data presented at IDWeek 2022, held in Washington, D.C.
“The 2019 [American Thoracic Society/Infectious Diseases Society of America] community-acquired pneumonia (CAP) guidelines recommended abandoning the definition of healthcare-associated pneumonia (HCAP) and to base the need for broad-spectrum antimicrobial coverage on local epidemiology and risk factors,” said Veronica B. Zafonte, PharmD, a clinical pharmacy specialist at Jamaica Hospital Medical Center, in New York City.
Dr. Zafonte and her colleagues sought to determine the prevalent risk factors for drug-resistant DRP in CAP in an urban population. The team hypothesized that Jamaica Hospital Medical Center would provide a unique patient population due to its location in an ethnically diverse, low socioeconomic area, fed by multiple nursing homes and a national and an international airport.
The researchers conducted a retrospective chart review of adult patients at least 18 years of age who were admitted from August 2018 through December 2019, who had a clinical and/or radiological diagnosis of pneumonia, and positive respiratory cultures for bacterial growth collected within 48 hours of admission (poster 2187). Patients who had a positive DRP respiratory culture within 48 hours of hospital admission were chosen, with the next consecutively admitted patient with a non-resistant culture matched as a control.
A total of 227 patients were included in the study: 114 patients were enrolled in the DRP cohort and 113 patients served as controls. Roughly 40% of the DRP cohort were admitted from long-term care facilities versus 8.8% of the control group. All DRIP score components were associated with the isolation of DRP in the patient population, except for methicillin-resistant S. aureus colonization.
Among the study participants, 50% of the DRP cohort had a DRIP score of 3 or less, and DRIP scores of at least 2, 3 and 4 had a low negative predictive value (NPV) for the isolation of DRP in CAP (71.9%, 67.4% and 64.2%, respectively).
“Using a DRIP score cutoff of over 4 missed 50% of the DRP in our study population,” Dr. Zafonte said. “Despite a DRIP score greater than 4 having a specificity of 90.3%, with an NPV of 64.2%, this scoring tool may underestimate the prevalence of DRP in our patient population.”
Based on the study findings, institutions should consider local validation of the DRIP score before implementing use at their sites, she concluded.
