medical decision support medical decision support
Sign In

Predicting Antibiotic Resistant Pneumonia in Institutionalized Patients

Purpose: To determine the risk of an antibiotic-resistant organism causing severe pneumonia in an elderly institutionalized patient based on the study of El Solh et al.

Description

El Solh et al identified risk factors for antibiotic resistant bacteria causing severe pneumonia in elderly institutionalized patients. They developed a classification tree to identify patients who should be suspected of having resistant organisms. The authors are from the University of Buffalo.


Patient selection: severe pneumonia in an elderly patient in a nursing home or other institution

 

Parameters:

(1) history of recent antibiotic therapy

(2) activities of daily living (ADL) as a measure of disability

 

Activities of daily living:

(1) transfer

(2) feeding

(3) bathing

(4) dressing

(5) toileting

(6) continence (fecal and/or urine)

 

ADL Level

Points

fully independent

1

partially dependent

2

completely dependent

3

 

total ADL score =

= SUM(points for all 6 ADL)

 

minimum total ADL score = 6 = fully independent

maximum total ADL score = 18 = bedridden and fully dependent

 

Recent Antibiotic Therapy

Total ADL Score

Probability of Antibiotic Resistance

none

< 12.5

0%

none

>= 12.5

17%

present

< 12.5

42%

present

>= 12.5

90%

from Figure 1, page 478

 

where:

• Since the ADL results are in whole numbers, I am not quite sure how a score of 12.5 can be achieved.

• The probability for antibiotic resistance in another institution might be different, although the relative ranking would be preserved.


To read more or access our algorithms and calculators, please log in or register.

Specialty

Objective

ICD-10