Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department.

MedStar author(s):
Citation: Clinical Infectious Diseases. 54(2):193-8, 2012 Jan 15.PMID: 22109951Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Methicillin-Resistant Staphylococcus aureus/ip [Isolation & Purification] | *Pneumonia, Bacterial/mi [Microbiology] | *Pseudomonas aeruginosa/ip [Isolation & Purification] | Adult | Aged | Analysis of Variance | beta-Lactamases/bi [Biosynthesis] | Cohort Studies | Emergency Service, Hospital/sn [Statistics & Numerical Data] | Female | Humans | Male | Methicillin-Resistant Staphylococcus aureus/py [Pathogenicity] | Middle Aged | Pneumococcal Infections/dt [Drug Therapy] | Pneumococcal Infections/ep [Epidemiology] | Pneumococcal Infections/mi [Microbiology] | Pneumonia, Bacterial/dt [Drug Therapy] | Pneumonia, Bacterial/ep [Epidemiology] | Pseudomonas aeruginosa/py [Pathogenicity] | Pseudomonas Infections/dt [Drug Therapy] | Pseudomonas Infections/mi [Microbiology] | Reproducibility of Results | Retrospective Studies | Risk Assessment/mt [Methods] | ROC Curve | Streptococcus pneumoniae/ip [Isolation & Purification] | Streptococcus pneumoniae/py [Pathogenicity] | Washington/ep [Epidemiology]Year: 2012Local holdings: Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007ISSN:
  • 1058-4838
Name of journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaAbstract: 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.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.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 beta-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.All authors: Hoban A, Hoffman J, Kan J, Kollef MH, Micek ST, Reichley R, Shorr AF, Zilberberg MDFiscal year: FY2013Digital Object Identifier: Date added to catalog: 2014-02-24
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 22109951 Available 22109951

Available online from MWHC library: June 1997 - present, Available in print through MWHC library: 1999 - Winter 2007

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.

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.

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 beta-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.

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