How do you decide which patients with bacterial pneumonia are likely to have antibiotic resistance? Decrease use of unnecessary coverage with the Drug Resistance in Pneumonia (DRIP) Score
Use the DRIP Score to predict the risk of community-acquired pneumonia due to drug-resistant pathogens. Calculate the total points for both Major and Minor Risk Factors. A score of ≥4 is associated with higher risk of drug-resistant pneumonia and extended-spectrum antibiotic coverage is recommended.
Major Risk Factors |
Points |
| Antibiotic use within 60 days | 2 |
| Long-term care resident, not including assisted living or group home | 2 |
| Tube feeding, with NG, nasojejunal or PEG tube | 2 |
| Drug-resistant PNA within last year | 2 |
Minor Risk Factors |
Points |
| Hospitalization within 60 days | 1 |
| Chronic pulmonary disease | 1 |
| Poor function status, Karnofsky score of <70 or non-ambulatory | 1 |
| H2 blocker or PPI use within 14 days | 1 |
| Active wound care | 1 |
| MRSA colonization within one year | 1 |
The GoodWhy Use It |
The BadLimitations |
The UglyMisapplication |
| ● Highlights risk factors for higher Abx resistance including recent Abx or hospitalization, tube feeds, chronic pulm disease and MRSA colonization
● Enables precision medicine by reserving combo anti-MRSA/anti-Pseudomonas therapy for patients with the highest pre-test probability for resistance ● Decreases unnecessary nephrotoxicity and C. diff risks from unnecessary combo Abx regimens |
● Limited to inpatient treatment of bacterial CAP
● Not perfectly sensitive (though more sensitive than HCAP criteria) ● Currently in use clinically, but likely needs more outcomes studies before widespread use |
● False negatives can occur with MRSA, P. aeruginosa, and in patients with COPD, IVDU, and psychiatric illness
● False positives occur for S pneumoniae and MSSA |
Derivation |
| ● 200 microbiologically-confirmed cases of pneumonia
● 18 risk factors evaluated with logistic regression ● DRIP study identified 4 major and 6 minor risk factors |
Validation |
| ● 200 patients from 4 hospitals
● Sens 0.82, spec 0.81, PPV 0.68, NPV 0.9, and accuracy 81.5%. ● DRIP outperformed 8 other predictive models, including the HCAP criteria, where DRIP resulted in 46% less use of extended-spectrum antibiotics |
Reference:
Webb BJ, Dascomb K, Stenehjem E, Vikram HR, Agrwal N, Sakata K, Williams K, Bockorny B, Bagavathy K, Mirza S et al. The DRIP score: derivation and prospective multi‐center validation of a model to predict drug resistance in community‐onset pneumonia. Antimicrob. Agents Chemother. 2016; 60: 2652–63.
2 Comments
Thanks Dr. Dayton good to hear your advice on this concern. Good Doctors does inform and you did. A GOOD Doctor.
Thanks for the love. Dr. Webb at Intermountain Healthcare is the genius behind this, and the folks at MDCalc have made a great algorithm to help us use it: https://www.mdcalc.com/drug-resistance-pneumonia-drip-score . I’m happy to help spread the word to our tribe of Emergency Physicians 😉