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. 2015 Apr 10;10(4):e0119528.
doi: 10.1371/journal.pone.0119528. eCollection 2015.

Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia

Marco Falcone  1 , Alessandro Russo  2 , Maddalena Giannella  3 , Roberto Cangemi  4 , Maria Gabriella Scarpellini  5 , Giuliano Bertazzoni  5 , José Martínez Alarcón  6 , Gloria Taliani  7 , Paolo Palange  2 , Alessio Farcomeni  8 , Annarita Vestri  8 , Emilio Bouza  9 , Francesco Violi  4 , Mario Venditti  2
Affiliations

Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia

Marco Falcone et al. PLoS One. .

Abstract

Introduction: The diffusion of multidrug-resistant (MDR) bacteria has created the need to identify risk factors for acquiring resistant pathogens in patients living in the community.

Objective: To analyze clinical features of patients with community-onset pneumonia due to MDR pathogens, to evaluate performance of existing scoring tools and to develop a bedside risk score for an early identification of these patients in the Emergency Department.

Patients and methods: This was an open, observational, prospective study of consecutive patients with pneumonia, coming from the community, from January 2011 to January 2013. The new score was validated on an external cohort of 929 patients with pneumonia admitted in internal medicine departments participating at a multicenter prospective study in Spain.

Results: A total of 900 patients were included in the study. The final logistic regression model consisted of four variables: 1) one risk factor for HCAP, 2) bilateral pulmonary infiltration, 3) the presence of pleural effusion, and 4) the severity of respiratory impairment calculated by use of PaO2/FiO2 ratio. A new risk score, the ARUC score, was developed; compared to Aliberti, Shorr, and Shindo scores, this point score system has a good discrimination performance (AUC 0.76, 95% CI 0.71-0.82) and calibration (Hosmer-Lemeshow, χ2 = 7.64; p = 0.469). The new score outperformed HCAP definition in predicting etiology due to MDR organism. The performance of this bedside score was confirmed in the validation cohort (AUC 0.68, 95% CI 0.60-0.77).

Conclusion: Physicians working in ED should adopt simple risk scores, like ARUC score, to select the most appropriate antibiotic regimens. This individualized approach may help clinicians to identify those patients who need an empirical broad-spectrum antibiotic therapy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow diagram.
Legend. ED: emergency department; HAP: hospital-acquired pneumonia.
Fig 2
Fig 2. Distribution of MDR pathogens in CAP and HCAP populations.
Legend. MDR: multidrug-resistant; CAP: community-acquired pneumonia; HCAP: health-care associated pneumonia.
Fig 3
Fig 3. Risk stratification of MDR isolation on the basis of ARUC score.
Legend. MDR: multidrug-resistant.
Fig 4
Fig 4. ROC curves of ARUC, Aliberti, Shorr and Shindo scores.
Legend. PPV: positive predictive value; NPV: negative predictive value.
Fig 5
Fig 5. ROC curves of ARUC score on the Spanish population.
See this image and copyright information in PMC

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