Perhimpunan Dokter Paru Indonesia - Clinical impact of a prediction score for drug-resistance in community-onset pneumonia
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Clinical impact of a prediction score for drug-resistance in community-onset pneumonia




Brandon Webb1, Jeff Sorensen3, Herman Post4, Peter Jones1, Dominika Swistun1, Al Jephson3 and Nathan Dean2
1Intermountain Healthcare, Division of Infectious Diseases, Salt Lake City, UTUnited States,?2Division of Pulmonary and Critical Care Medicine, Intermountain Healthcare and the University of Utah, Salt Lake City, UTUnited States,?3Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UTUnited States,?4Homer Warner Center for Informatics Research, Intermountain Healthcare, Murray, UTUnited States

Introduction Use of HCAP criteria for predicting drug-resistance in community-onset pneumonia results in overuse of broad-spectrum antibiotics. We derived and validated an alternative prediction tool (DRIP) (Webb AAC 2016) and integrated it into an electronic decision support tool used in 4 U.S. hospitals.

Aims Compare DRIP to HCAP for prediction of drug-resistance and evaluate antibiotic usage and outcomes in a prospective implementation study.

Methods Physician use of the electronic tool and calculation of DRIP was optional. For DRIP ≥4 anti-pseudomonal, vancomycin and azithromycin therapy was recommended. We identified two concurrent cohorts from 11/2014 to 10/2015: 1) cases where DRIP was calculated and 2) usual care. We compared observed rates of antibiotic use between groups and used logistic regression to severity adjust outcomes.

Results DRIP and usual care comprised 894 and 324 inpatients. Drug resistance incidence was 2.4% and 4%. Severity was higher for usual care. Compared to HCAP, DRIP demonstrated equivalent sensitivity but better specificity. Inadequate therapy was <1% in both groups. Relative reduction in unnecessary broad spectrum use (25.9% p=0.008) was observed in the DRIP group. DRIP was associated with decreased length of stay (LOS) (coeff ? 0.147; upper 95% CI ? 0.137; p < 0.001). Odds of in-hospital mortality did not reach statistical significance (OR 0.643; upper 95% CI 1.04; p = 0.063).

DRIP % Usual Care % p=
Inadequate Spectrum 0.67 0.93 NS
Overtreatment 20.6 27.8 0.008
Appropriate Spectrum 78.6 71.0 0.005
TABLE 1.
DRIP versus Usual Care

Conclusion DRIP use was associated with reduced unnecessary broad-spectrum antibiotic use and LOS, without increased inadequate therapy or mortality.

http://erj.ersjournals.com/content/48/suppl_60/PA607



PDPI Malang. 13/03/17.



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