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    Drug Resistance in Pneumonia (DRIP) Score

    Predicts risk for community-acquired pneumonia due to drug-resistant pathogens.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with community acquired pneumonia.

    • Should be utilized only for bacterial causes of pneumonia.
    • False negatives can be seen in the following situations: MRSA or P. aeruginosa infection, severe COPD (requiring O₂ and steroids), IV drug use, psychiatric conditions, and homelessness.
    • False positives can be seen with S. pneumoniae and MSSA.
    • The DRIP validation study evaluated a broader set of risk factors than the HCAP definition.
    • The DRIP study reaffirmed that antibiotic use and hospitalization 60 days prior are major contributors to drug resistance, but did not find a strong association between severity of illness and drug resistance.
    • More predictive of drug resistant pathogens compared to HCAP and may have the potential to decrease antibiotic over-utilization in pneumonia.
    • Decreases use of unnecessary extended-spectrum antibiotics by 38% as compared with the HCAP definition (Webb 2019).
    • At a cut-off of ≥4 points, DRIP optimally differentiates high and low risk (PPV of 73.0, NPV 92.0, AUROC 0.88, accuracy of 87%), supporting its utility as a clinical decision tool to guide empiric antibiotic selection. Accuracy was defined as “percent of cases in which antibiotic spectrum (that would have been recommended based on DRIP classification) would have been appropriate for the recovered organism.”
    Major Risk Factors
    No
    0
    Yes
    +2
    No
    0
    Yes
    +2
    No
    0
    Yes
    +2
    No
    0
    Yes
    +2
    Minor Risk Factors
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    The goal of the DRIP Score is to determine when broad spectrum antibiotics should be used, both to be effective with treatment and to avoid increasing antibiotic resistance.

    Management

    • A patient with a DRIP Score <4 can effectively be treated without broad-spectrum antibiotic coverage.
    • A patient with a DRIP Score of ≥4 is more likely to require broad-spectrum antibiotic coverage.
    Content Contributors
    • John Dayton, MD
    About the Creator
    Dr. Brandon Webb
    Content Contributors
    • John Dayton, MD