Potential Impact of the DRIP Score on Antibiotic Use: a Retrospective Single-Center Study

Abstract

BackgroundThe Drug Resistance in Pneumonia score (DRIP) is a recently developed prediction tool to identify patients with community-acquired pneumonia (CAP) at increased risk for drug resistant pathogens (DRP). The DRIP score has better performance characteristics than other available prediction tools which have been associated with increased broad-spectrum antibiotic use. We evaluated the potential impact of the DRIP score on CAP management at the Salt Lake City VA, a 106 bed facility with a Hospitalist service staffed by Internal Medicine residents and Department of Medicine faculty and an antibiotic stewardship program (ASP).MethodsWe performed a retrospective chart review of adult inpatients with pneumonia present on admission based on ICD9/10 coding between February 2016 and April 2017. Both DRIP and HCAP scores were calculated for each patient and antibiotic selection was collected by manual chart review. We compared actual antibiotic selection with potential changes in broad-spectrum antibiotic use in all patients and patients with a DRIP score ≥4, the cutoff where broad-spectrum antibiotic use is suggested. Microbiology results, mortality, and 30-day readmission were also collected.ResultsWe identified 184 patients during the study period. Respiratory cultures were obtained in 27% (50/184) of participants with 2% (3/184) positive for a CAP-DRp. 7% (12/169) were positive for MRSA colonization upon admission. 24% (45/184) had DRIP ≥4 as compared with 47% (87/184) meeting HCAP criteria. 158 were treated for bacterial pneumonia of which 85% (134/158) received CAP antibiotics. Strict DRIP adherence upon admission would have led to 13% (21/158) more patients on broad-spectrum antibiotics. In the subset of patients with a DRIP score ≥4, DRIP adherence would have led to 65% (26/40) more patients on broad-spectrum antibiotics. 30-day mortality (9%) and readmission (15%) rates were comparable with Centers for Medicare Services (CMS) statistics.ConclusionIn the setting of robust ASP efforts and low rates of DRPs, the DRIP score may lead to increased use of broad-spectrum antibiotics. The impact of the DRIP score on antibiotic use and clinical outcomes warrants further large-scale evaluation in a variety of settings.Disclosures All authors: No reported disclosures.