TY - JOUR
T1 - Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department
AU - Shorr, Andrew F.
AU - Zilberberg, Marya D.
AU - Reichley, Richard
AU - Kan, Jason
AU - Hoban, Alex
AU - Hoffman, Justin
AU - Micek, Scott T.
AU - Kollef, Marin H.
N1 - Funding Information:
Potential conflicts of interest. A. F. S. has served as a consultant to or speaker for or has received grant support from Astellas, Bayer, Forrest, Pfizer, Theravance, and Trius. M. D. Z. has served as a consultant to or has received grant support from Astellas, Forrest, J and J, and Pfizer. M. H. K. has served as a consultant to or speaker for or has received grant support from Cubist, Hospria, Merck, and Sage. S. T. M. has received grant support from Cubist, Optimer, Merck, and Pfizer. All other authors report no potential conflicts.
Funding Information:
Financial support. This work was supported by the Barnes-Jewish Hospital Foundation.
PY - 2012/1/15
Y1 - 2012/1/15
N2 - (See the Editorial Commentary by Murri and De Pascale, on pages 199-201.)Background. Resistant organisms (ROs) are increasingly implicated in pneumonia in patients presenting to the emergency department (ED). The concept of healthcare-associated pneumonia (HCAP) exists to help identify patients infected with ROs but may be overly broad. We sought to validate a previously developed score for determining the risk for an RO and to compare it with the HCAP definition.Methods.We evaluated adult patients admitted via the ED with bacterial pneumonia (January-December 2010). We defined methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and extended-spectrum β-lactamases as ROs. The risk score was as follows: 4, recent hospitalization; 3, nursing home; 2, chronic hemodialysis; 1, critically ill. We evaluated the screening value of the score and of HCAP by determining their areas under the receiver-operating characteristic (AUROC) curves for predicting ROs. Results. The cohort included 977 patients, and ROs were isolated in 46.7%. The most common organisms included MRSA (22.7%), P. aeruginosa (19.1%), and Streptococcus pneumoniae (19.1%). The risk score was higher in those with an RO (median score, 4 vs 1; P <. 001). The AUROC for HCAP equaled 0.62 (95% confidence interval [CI],. 58-.65) versus 0.71 (95% CI,. 66-.73) for the risk score. As a screening test for ROs, a score > 0 had a high negative predictive value (84.5%) and could lead to fewer patients unnecessarily receiving broad-spectrum antibiotics.Conclusions.ROs are common in patients presenting to the ED with pneumonia. A simple clinical risk score performs moderately well at classifying patients regarding their risk for an RO.
AB - (See the Editorial Commentary by Murri and De Pascale, on pages 199-201.)Background. Resistant organisms (ROs) are increasingly implicated in pneumonia in patients presenting to the emergency department (ED). The concept of healthcare-associated pneumonia (HCAP) exists to help identify patients infected with ROs but may be overly broad. We sought to validate a previously developed score for determining the risk for an RO and to compare it with the HCAP definition.Methods.We evaluated adult patients admitted via the ED with bacterial pneumonia (January-December 2010). We defined methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and extended-spectrum β-lactamases as ROs. The risk score was as follows: 4, recent hospitalization; 3, nursing home; 2, chronic hemodialysis; 1, critically ill. We evaluated the screening value of the score and of HCAP by determining their areas under the receiver-operating characteristic (AUROC) curves for predicting ROs. Results. The cohort included 977 patients, and ROs were isolated in 46.7%. The most common organisms included MRSA (22.7%), P. aeruginosa (19.1%), and Streptococcus pneumoniae (19.1%). The risk score was higher in those with an RO (median score, 4 vs 1; P <. 001). The AUROC for HCAP equaled 0.62 (95% confidence interval [CI],. 58-.65) versus 0.71 (95% CI,. 66-.73) for the risk score. As a screening test for ROs, a score > 0 had a high negative predictive value (84.5%) and could lead to fewer patients unnecessarily receiving broad-spectrum antibiotics.Conclusions.ROs are common in patients presenting to the ED with pneumonia. A simple clinical risk score performs moderately well at classifying patients regarding their risk for an RO.
UR - http://www.scopus.com/inward/record.url?scp=84555209205&partnerID=8YFLogxK
U2 - 10.1093/cid/cir813
DO - 10.1093/cid/cir813
M3 - Article
C2 - 22109951
AN - SCOPUS:84555209205
VL - 54
SP - 193
EP - 198
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 2
ER -