Validation of the Drip Score at A Community-Teaching Hospital

Abstract

Rationale Recent data suggest that health care–associated pneumonia (HCAP) criteria has poor predictive value in determining risk for drug-resistant pathogens (DRPs) and leads to increased use of broad-spectrum antibiotics. The Drug Resistance in Pneumonia (DRIP) Score highlights a selective set of criteria to predict pneumonia risk. Validation studies show conflicting results on the impact of antibiotic selection based on the DRIP score. Methods This was a retrospective chart review of hospitalized patients from March 2018 to April 2018 who were started on antibiotics for a respiratory tract infection. The HCAP criteria and DRIP scores were calculated and antibiotic selection was analyzed. The primary focus was to determine if utilization of the DRIP score could modify antipseudomonal beta-lactam (APBL) prescribing patterns. Results A total of 82 patients were included in the study. Sixty-four (78%) patients had a DRIP score <4 with 19 (30%) receiving an APBL. There were 18 patients with a DRIP score >4, and 7 (39%) patients received non-APBL antibiotics. The HCAP criteria and subsequent prescribing was also analyzed. Forty-nine patients were identified as not meeting HCAP criteria. Of these patients, 12 (24%) received APBL. Thirty-three patients met HCAP criteria, and 15 (45%) received a non-APBL. If HCAP criteria were used to guide antibiotic prescribing, we would see a net increase of 3% in APBL use; whereas if DRIP scores were implemented, we would see a net decrease of 14% in APBL use. Conclusions Our study indicates that implementation of the DRIP score would result in decreased empiric APBL use.