• Chest · Nov 2019

    Antibiotic use and outcomes after implementation of the Drug Resistance in Pneumonia (DRIP) score in emergency department patients with community-onset pneumonia.

    • Brandon J Webb, Jeffrey Sorensen, Ian Mecham, Whitney Buckel, Lilian Ooi, Al Jephson, and Nathan C Dean.
    • Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT; Division of Infectious Diseases and Geographic Medicine, Stanford Medicine, Palo Alto, CA. Electronic address: Brandon.Webb@imail.org.
    • Chest. 2019 Nov 1; 156 (5): 843-851.

    BackgroundTo guide rational antibiotic selection in community-onset pneumonia, we previously derived and validated a novel prediction tool, the Drug-Resistance in Pneumonia (DRIP) score. In 2015, the DRIP score was integrated into an existing electronic pneumonia clinical decision support tool (ePNa).MethodsWe conducted a quasi-experimental, pre-post implementation study of ePNa with DRIP score (2015) vs ePNa with health-care-associated pneumonia (HCAP) logic (2012) in ED patients admitted with community-onset pneumonia to four US hospitals. Using generalized linear models, we used the difference-in-differences method to estimate the average treatment effect on the treated with respect to ePNa with DRIP score on broad-spectrum antibiotic use, mortality, hospital stay, and cost, adjusting for available patient-level confounders.ResultsWe analyzed 2,169 adult admissions: 1,122 in 2012 and 1,047 in 2015. A drug-resistant pathogen was recovered in 3.2% of patients in 2012 and 2.8% in 2015; inadequate initial empirical antibiotics were prescribed in 1.1% and 0.5%, respectively (P = .12). A broad-spectrum antibiotic was administered in 40.1% of admissions in 2012 and 33.0% in 2015 (P < .001). Vancomycin days of therapy per 1,000 patient days in 2012 were 287.3 compared with 238.8 in 2015 (P < .001). In the primary analysis, the average treatment effect among patients using the DRIP score was a reduction in broad-spectrum antibiotic use (OR, 0.62; 95% CI, 0.39-0.98; P = .039). However, the average effects for ePNa with DRIP on mortality, length of stay, and cost were not statistically significant.ConclusionsElectronic calculation of the DRIP score was more effective than HCAP criteria for guiding appropriate broad-spectrum antibiotic use in community-onset pneumonia.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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