Gonzalez-Del Castillo et al reported a score for identifying a patient whose oropharynx may be colonized by a potential pathogen. This can help to identify a patient with pneumonia who may have more serious disease. The authors are from Hospital Clinico San Carlos, Hospital Universitario Monte-Principe, and Regional Healthcare Medical Coordinator of Social Affairs in Madrid.
Patient selection: older adult with pneumonia
Pathogenesis of pneumonia: micro-aspirations of oropharyngeal flora
Pathogens that may be involved: Staphylococcus aureus, Gram-negative enteric bacteria
Parameters:
(1) Barthel index (BA), over a range from 0 to 100
(2) hypertension (H)
(3) neuromuscular disease (N)
(4) gastrostomy (G), with PEG
Parameter
Finding
Points
Barthel index
>= 90
0
< 90
2
hypertension
no
0
yes
3
neuromuscular disease
no
0
yes
6
gastrostomy/PEG
no
0
yes
4
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The risk of colonization of the oropharynx by a potential pathogen increases as the score increases.
• The risk may influence the choice of antibiotics to use when treating pneumonia.
Score
Risk Group
Percentage
0 to 2
low
4.1%
3 to 5
intermediate
15.8%
6 to 15
high
57.1%
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