Development and validation of a clinical risk score for predicting drug-resistant bacterial pneumonia in older Chinese patients

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Abstract

Background and objective:

Health care-associated pneumonia (HCAP) and drug-resistant bacterial pneumonia may not share identical risk factors. We have shown that bronchiectasis, recent hospitalization and severe pneumonia (confusion, blood urea level, respiratory rate, low blood pressure and 65 year old (CURB-65) score ≥3) were independent predictors of pneumonia caused by potentially drug-resistant (PDR) pathogens. This study aimed to develop and validate a clinical risk score for predicting drug-resistant bacterial pneumonia in older patients.

Methods:

We derived a risk score by assigning a weighting to each of these risk factors as follows: 14, bronchiectasis; 5, recent hospitalization; 2, severe pneumonia. A 0.5 point was defined for the presence of other risk factors for HCAP. We compared the areas under the receiver-operating characteristics curve (AUROC) of our risk score and the HCAP definition in predicting PDR pathogens in two cohorts of older patients hospitalized with non-nosocomial pneumonia.

Results:

The derivation and validation cohorts consisted of 354 and 96 patients with bacterial pneumonia, respectively. PDR pathogens were isolated in 48 and 21 patients in the derivation and validation cohorts, respectively. The AUROCs of our risk score and the HCAP definition were 0.751 and 0.650, respectively, in the derivation cohort, and were 0.782 and 0.671, respectively, in the validation cohort. The differences between our risk score and the HCAP definition reached statistical significance. A score ≥2.5 had the best balance between sensitivity and specificity.

Conclusions:

Our risk score outperformed the HCAP definition to predict pneumonia caused by PDR pathogens. A history of bronchiectasis or recent hospitalization is the major indication of starting empirical broad-spectrum antibiotics.

Conclusions:

This prospective cohort study shows that risk stratification with a clinical risk score is better than the HCAP definition in predicting drug-resistant bacterial pneumonia. The presence of bronchiectasis or recent hospitalization is the most important indication of starting empirical broad-spectrum antibiotics.

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