Antibiotic use and outcomes after implementation of the Drug Resistance in Pneumonia (DRIP) score in emergency department patients with community-onset pneumonia.
Chest. 2019 May 08;:
Authors: Webb BJ, Sorensen J, Mecham I, Buckel W, Ooi L, Jephson A, Dean NC
BACKGROUND: To 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 DRIP was integrated into an existing electronic clinical decision support tool for pneumonia (ePNa).
METHODS: We conducted a quasi-experimental, pre-post implementation study of ePNa with DRIP (2015) vs ePNa with HCAP logic (2012) in emergency department patients admitted with community-onset pneumonia to four U.S. 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 on broad-spectrum antibiotic use, mortality, hospital stay and cost, adjusting for available patient-level confounders.
RESULTS: We analyzed 2169 adult admissions, 1122 in 2012 and 1047 in 2015. A drug-resistant pathogen was recovered in 3.2% of patients in 2012 and 2.8% in 2015; inadequate initial empiric antibiotics were prescribed in 1.1% and 0.5% respectively (p=0.12). A broad-spectrum antibiotic was administered in 40.1% of admissions in 2012 and 33.0% in 2015 (p<0.001). Vancomycin days of therapy per 1000 patient days in 2012 were 287.3 compared to 238.8 in 2015 (p<0.001). In the primary analysis, the average treatment effect among patients using DRIP was a reduction in broad-spectrum antibiotic use (OR 0.62, CI 0.39 to 0.98, p=0.039). However, the average effects for ePNa with DRIP on mortality, length of stay and cost were not statistically significant.
CONCLUSIONS: Electronic calculation of the DRIP score was more effective than HCAP criteria for guiding appropriate broad-spectrum antibiotic use in community-onset pneumonia.
PMID: 31077649 [PubMed - as supplied by publisher]