Patient selection: adult with community-onset pneumonia
Parameters:
(1) recent antibiotic use (within past 60 days)
(2) usual residence
(3) tube feeding
(4) history of drug-resistant pneumonia within the past year
(5) recent hospitalization (within past 60 days)
(6) COPD
(7) functional status
(8) gastric acid suppression
(9) wound care
(10) history of MRSA colonization within the past year
|
Parameter
|
Finding
|
Points
|
|
recent antibiotic use
|
No
|
0
|
|
|
yes (within past 60 days)
|
2
|
|
usual residence
|
not long-term care
|
0
|
|
|
long-term care
|
2
|
|
tube feeding
|
No
|
0
|
|
|
Yes
|
2
|
|
history of drug-resistant pneumonia within past year
|
No
|
0
|
|
|
Yes
|
2
|
|
recent hospitalization
|
No
|
0
|
|
|
Yes
|
1
|
|
COPD
|
No
|
0
|
|
|
Yes
|
2
|
|
functional status
|
good or fair
|
0
|
|
|
Poor
|
1
|
|
gastric acid suppression
|
No
|
0
|
|
|
yes
|
1
|
|
wound care
|
No
|
0
|
|
|
yes
|
1
|
|
MRSA colonization
|
No
|
0
|
|
|
yes
|
1
|
where:
• Items scored 2 are the major risk factors.
• Wound care tends to be seen in patients with diabetes and/or peripheral arterial disease.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The higher the score the greater the risk of a drug-resistant pathogen.
• A score >= 4 was associated with increased risk for antibiotic resistance.
Performance:
• The area under the ROC curve was 0.88.
• At a cutoff of >= 4 the sensitivity was 82% and specificity 81%.
