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    Patent Pending

    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 46% as compared with the HCAP definition.
    • 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
    Minor Risk Factors

    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.

    Formula

    Addition of the selected points:

    Risk Factor

    Points

    Major

    Antibiotic use within 60 days

    2

    Long term care resident*

    2

    Tube feeding**

    2

    Prior drug-resistant pneumonia within 1 year

    2

    Minor

    Prior hospitalization  within 60 days

    1

    Chronic pulmonary disease

    1

    Poor functional status***

    1

    H2 blocker or PPI within 14 days

    1

    Active wound care at time of admission

    1

    MRSA colonization within 1 year

    1

    *Including long term acute care, skilled nursing, and inpatient rehabilitation but not assisted living or group home facilities.

    **Nasogastric, nasojejunal, or percutaneous gastrostomy.

    ***Karnofsky Performance Status <70 or non-ambulatory status.

    Facts & Figures

    Interpretation:

    DRIP Score

    Interpretation

    <4

    Low risk of drug-resistant pneumonia. Consider treating without extended-spectrum antibiotics.

    ≥4

    High risk of drug-resistant pneumonia. Extended-spectrum antibiotics likely necessary.

    Evidence Appraisal

    • Webb et al created the DRIP Score with their study that both derived and validated a clinical prediction tool to help predict which cases of bacterial pneumonia may be antibiotic resistant. Their research goal was to create a predictive score more accurate than HCAP.   
    • During the derivation portion of the study, multiple risk factors for drug resistant pathogens were evaluated using logistic regression for a cohort of 200 cases of confirmed bacterial pneumonia.
    • Compared to HCAP, the DRIP Score is more sensitive (82% vs 79%), more specific (81% vs 65%), and decreases use of unnecessary extended-spectrum antibiotics by 46%.
    • The DRIP Score was also more specific and more accurate than eight other predictive models, including the Shorr Score.
    Dr. Brandon Webb

    About the Creator

    Brandon Webb, MD, is a practicing infectious disease physician in the division of epidemiology and infectious diseases at Intermountain Healthcare in Utah. He has also served as an adjunct assistant professor at the University of Utah School of Medicine. Dr. Webb's research interests include bacterial pneumonia, antimicrobial stewardship, and transplant infectious diseases.

    To view Dr. Brandon Webb's publications, visit PubMed

    Content Contributors
    • John Dayton, MD
    About the Creator
    Dr. Brandon Webb
    Content Contributors
    • John Dayton, MD