The 2019 American Thoracic Society and the Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend that drug-resistant pathogens (DRP) be empirically covered if locally validated risk factors are present. This retrospective case-control validation study evaluated the performance of the drug resistance in pneumonia (DRIP) clinical prediction score. Two hundred seventeen adult patients with ICD-10 (https://www.who.int/classifications/classification-of-diseases) pneumonia diagnosis, positive confirmed microbiologic data, and clinical signs and symptoms were included. A DRIP score of ≥4 was used to assess model performance. Logistic regression was used to select for significant predictors and create a modified DRIP score, which was evaluated to define clinical application. The DRIP score predicted pneumonia due to a DRP with a sensitivity of 67% and specificity of 73%. The area under the receiver operating characteristic (AUROC) curve was 0.76 (95% confidence interval [CI], 0.69 to 0.82). From regression analysis, prior infection with a DRP and antibiotics in the last 60 days, yielding scores of 2 points and 1 point, respectively, remained local risk factors in predicting drug-resistant pneumonia. Sensitivity (47%) and specificity (94%) were maximized at a threshold of ≥2 in the modified DRIP model. Therefore, prior infection with a DRP remained the only clinically relevant predictor for drug-resistant pneumonia. The original DRIP score demonstrated a decreased performance in our patient population and behaved similarly to other clinical prediction models. Empiric CAP therapy without anti-methicillin-resistant Staphylococcus aureus and antipseudomonal coverage should be considered for noncritically ill patients without a drug resistant pathogen infection in the past year. Our data support the necessity of local validation to authenticate clinical risk predictors for drug-resistant pneumonia.

中文翻译：

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验证社区获得性肺炎评分以改善学术医学中心的经验性抗生素选择

2019年美国胸科学会和美国传染病学会社区获得性肺炎（CAP）指南建议，如果存在本地验证的危险因素，则应从经验上涵盖耐药性病原体（DRP）。这项回顾性病例对照验证研究评估了肺炎耐药性（DRIP）临床预测评分的表现。包括ICD-10（https://www.who.int/classifications/classification-of-diseases）肺炎诊断的217名成年患者，确诊的微生物学数据以及临床体征和症状。DRIP得分≥4被用于评估模型性能。Logistic回归用于选择重要的预测指标，并创建修改后的DRIP得分，并对其进行评估以定义临床应用。DRIP评分可预测DRP引起的肺炎，敏感性为67％，特异性为73％。接收器工作特性（AUROC）曲线下方的面积为0.76（95％置信区间[CI]，0.69至0.82）。从回归分析来看，过去60天内使用DRP和抗生素的先前感染分别产生2分和1分的得分仍然是预测耐药性肺炎的局部危险因素。在改良的DRIP模型中，灵敏度（47％）和特异性（94％）在阈值≥2时达到最大。因此，先前的DRP感染仍然是耐药性肺炎的唯一临床相关预测因子。最初的DRIP评分显示出我们患者群体中的表现下降，并且表现与其他临床预测模型相似。没有抗甲氧西林耐药的经验性CAP治疗在过去的一年中，对于没有药物耐药性病原体感染的非重症患者，应考虑金黄色葡萄球菌和抗假性流感疫苗的覆盖范围。我们的数据支持进行本地验证以鉴定耐药性肺炎的临床风险预测指标的必要性。