Schreiber et al developed a simple score for identifying patients with pneumonia and respiratory failure who are infected with an antibiotic-resistant pathogen. The authors are from Washington Hospital Center in Washington, D.C.
Patient selection: adult > 18 years of age with pneumonia with respiratory failure
Parameters:
(1) immunosuppression (AIDS, active malignancy being treated with chemotherapy, immunosuppressive therapy such as prednisone 10 mg per day for >= 30 days, methotrexate, etc)
(2) admission from long-term care facility
(3) history of prior antibiotics
Parameter
Finding
Points
immunosuppression
absent
0
present
3
long-term care facility
no
0
yes
2
history of antibiotics
no
0
yes
1
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the chance of a resistant pathogen causing the pneumonia.
Score
Percent Resistant
0 or 1
20%
2 or 3
40%
4 to 6
80%
Performance:
• The area under the ROC curve was 0.71.
• A cutoff of >= 2 had a sensitivity of 81% and specificity of 63%.
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