Clinical Predictors for Laboratory-Confirmed Influenza Infections: Exploring Case Definitions for Influenza-Like Illness

2015 ◽  
Vol 36 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Shital C. Shah ◽  
Dino P. Rumoro ◽  
Marilyn M. Hallock ◽  
Gordon M. Trenholme ◽  
Gillian S. Gibbs ◽  
...  
Keyword(s):  
Influenza A ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Case Definition ◽  
Chief Complaint ◽  
Nasopharyngeal Swab ◽  
Clinical Predictors ◽  
Case Definitions ◽  
Influenza Like Illness

OBJECTIVETo identify clinical signs and symptoms (ie, “terms”) that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza.DESIGNRetrospective, cross-sectional study.SETTINGLarge urban academic medical center hospital.PARTICIPANTSA total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011.METHODSAn electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.RESULTSThe best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%–92% and specificity=38%–44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data.CONCLUSIONSA simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0–4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.Infect Control Hosp Epidemiol 2015;00(0): 1–8

scholarly journals Relationship Between Baseline Influenza-like Illness Rates And Healthcare Settings

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Dino Rumoro ◽  
Shital Shah ◽  
Gillian Gibbs ◽  
Marilyn Hallock ◽  
Gordon Trenholme ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Chief Complaint ◽  
Surveillance Program ◽  
Free Text ◽  
Patient Acuity ◽  
Influenza Like Illness ◽  
Healthcare Settings ◽  
Standard Deviations ◽  
The Guardian

ObjectiveTo examine the baseline influenza-like illness (ILI) rates in theemergency departments (ED) of a large academic medical center(AMC), community hospital (CH), and neighboring adult andpediatric primary care clinics.IntroductionThe primary goal of syndromic surveillance is early recognitionof disease trends, in order to identify and control infectious diseaseoutbreaks, such as influenza. For surveillance of influenza-like illness(ILI), public health departments receive data from multiple sourceswith varying degrees of patient acuity, including outpatient clinicsand emergency departments. However, the lack of standardization ofthese data sources may lead to varying baseline levels of ILI activitywithin a local area.MethodsGeographic Utilization of Artificial Intelligence in Real-Timefor Disease Identification and Alert Notification (GUARDIAN) – asyndromic surveillance program – was used to automate ILI detectionusing free text chief complaint/reason for visit fields and vital signsfor a large AMC - ED, CH - ED, and neighboring outpatient clinicsduring the summer (June 15, 2016 to August 18, 2016) in order tocreate a baseline. The GUARDIAN system defined ILI as fever(temperature≥100°F) and cough and/or sore throat. Descriptiveanalysis of the observed ILI rates along with bivariate ANOVA withpost hoc Bonferroni and t-test were utilized to examine the differencewithin the settings.ResultsThe average ILI rate for EDs is higher than the clinics by at least0.39%. The CH- ED had 4.23% baseline ILI rate as compared to1.35% for AMC-ED. While the AMC – Clinics have 0.96% baselineILI rate as compared to 0.25% for CH – Clinics. The CH- ED andAMC – Clinics represented higher variations. Based on bivariate test,CH – ED was significantly different than AMC – ED, AMC - Clinics,and CH – Clinics (F= 10.58, df = 1238, p<0.05). For the AMC –Clinics, the average ILI rate for clinics providing services to adultpatients was 0.66% (SD: 4.5%) as compared to 2.03% (SD: 10.81%)for pediatric clinics, which was not statistically significant.ConclusionsThe CH - ED has higher baseline ILI rates compared to othersettings, as well as the CDC Region 5’s baseline (1.9% for 2015-2016). Based on previous studies1, this is likely due to providers’use of chief complaint free text fields. Thus, the CH – ED will havehigher thresholds for widespread ILI activity. In addition, differencesin baseline ILI rates between AMC - ED, AMC - Clinics, and CH -Clinics may result in different thresholds for widespread ILI activity(i.e., Average + 3 Standard Deviations). The CH – ED and AMC –Clinics had higher baseline standard deviations, indicting variationsin underlying patient populations. In addition, pediatric clinics havehigher baseline ILI activity but also higher variations, indicating theunique characteristics of pediatric patients. Thus, due to the abovefindings, there is a need to closely monitor the ILI rates at varioushealthcare sites for both timing of onset, as well as the intensity ofILI activity.

scholarly journals Healthcare personnel absenteeism, presenteeism, and staffing challenges during epidemics

2020 ◽  
pp. 1-4
Author(s):  
Douglas W. Challener ◽  
Laura E. Breeher ◽  
JoEllen Frain ◽  
Melanie D. Swift ◽  
Pritish K. Tosh ◽  
...  
Keyword(s):  
Seasonal Influenza ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Healthcare Personnel ◽  
Linear Regression Models ◽  
Influenza Like Illness ◽  
Healthcare Workforce ◽  
Academic Medical ◽  
Hourly Employees

Abstract: Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. Design: Retrospective cohort study. Setting: Large academic medical center in the United States. Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.

Differences in clinical predictors of influenza in adults and children with influenza-like illness

Open Medicine ◽  
2010 ◽  
Vol 5 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Maja Sočan ◽  
Katarina Prosenc ◽  
Mateja Nagode
Keyword(s):  
Clinical Data ◽  
Predictive Value ◽  
Influenza A ◽  
Influenza Infection ◽  
Care Hospital ◽  
Rt Pcr ◽  
Clinical Predictors ◽  
Influenza Like Illness ◽  
Breath Sounds ◽  
Sensitivity Specificity

AbstractInfluenza contributes significantly to morbidity and mortality in the winter season. The aim of the study was to identify clinical signs and symptoms most predictive of influenza infection in children and adults with influenza-like illness. A prospective systematic sampling analysis of clinical data collected through sentinel surveillance system for influenza in 32 primary care centers and one tertiary care hospital in Slovenia during two consecutive influenza seasons (2004/2005 and 2005/2006) was carried out. Children and adults who had influenza-like illness, defined as febrille illness with sudden onset, prostration and weakness, muscle and joint pain and at least (cough, sore throat, coryza) were included and tested for influenza A and B virus, adenovirus, respiratory syncytial virus and enterovirus by RT-PCR. Clinical data were evaluated in statistical models to identify the best predictors for the confirmation of influenza for children (under age of 15) and adults. Of 1,286 patients with influenza-like symptoms in both seasons 211 were confirmed to have influenza A or B alone and compared to 780 influenza-negative patients. A fever over 38°C, chills, headache, malaise and sore eyes revealed a significant association with positive RT-PCR test for influenza virus in children. In adults, only three symptoms were significantly related to PCR-confirmed influenza infection: fever, cough and abnormal breath sounds. The stepwise logistic regression analysis showed that four symptoms predicted influenza in children: fever (38°C or more) (p=0.010), headache (p=0.030), cough (p=0.044) and absence of abnormal breathing sounds (p=0.015) with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 5.1%, 98.1%, 57.1% and 80.1%, respectively. For adults, the strongest impact on influenza positivity was found for fever (p=0.008) and cough (p=0.085). The model for adults had less favorable characteristics, with sensitivity, specificity, PPV and NPV of 0%, 100%, 0% and 76.4%, respectively. Differences in clinical predictors of influenza in children compared to adults were found. The model for adults was acceptable but not a good one. The model for children was found to be more reliable than the prediction model for adults.

scholarly journals A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants

2013 ◽  
Vol 169 (5) ◽  
pp. 529-536 ◽  
Author(s):  
Chin-Chun Chang ◽  
Chih-Jen Cheng ◽  
Chih-Chien Sung ◽  
Tzong-Shi Chiueh ◽  
Chien-Hsing Lee ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Periodic Paralysis ◽  
Strenuous Exercise ◽  
Oral Glucose ◽  
Upper Respiratory Tract ◽  
Precipitating Factors ◽  
Loading Test ◽  
Thyrotoxic Periodic Paralysis

BackgroundA comprehensive analysis has not been performed on patients with thyrotoxic periodic paralysis (TPP) characterized by acute hypokalemia and paralysis in the setting of thyrotoxicosis.PurposeThe aim of this study was to analyze the detailed symptomatology of thyrotoxicosis and precipitating factors for the attack in a large cohort of TPP patients.Patients and methodsA prospective observational study enrolled patients with TPP consecutively over 10 years at an academic medical center. Clinical features, including signs/symptoms of thyrotoxicosis and precipitating factors, were analyzed. The Wayne's index was used to assess the severity of thyrotoxicosis at presentation. Patients who agreed to receive an oral glucose-loading test after recovery were evaluated.ResultsAmong the 135 TPP patients (male:female, 130:5), 70% of paralytic attacks occurred in the morning, especially during the seasons of summer and fall. Two-thirds of patients did not have a known family or personal history of hyperthyroidism. Only 17% of TPP patients manifested overt signs/symptoms of thyrotoxicosis (Wayne's index >19). A clear precipitating factor, such as high carbohydrate load, acute upper respiratory tract infection, strenuous exercise, high-salt diet, or the use of steroids or bronchodilators, was identified in only 34% of TPP patients. A glucose load to stimulate insulin secretion induced acute hypokalemia (K+2.47±0.6 mmol/l) with reparalysis in only 18% (10/55) of TPP patients.ConclusionsMost TPP patients have only subtle clinical signs/symptoms of thyrotoxicosis and only a small fraction has clear precipitating factors. In addition to the effects of hyperinsulinemia, other insulin-independent mechanisms may participate in the pathogenesis of TPP.

scholarly journals Influenza A Outbreak in an Ambulatory Stem Cell Transplant Center

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Senu Apewokin ◽  
Keyur Vyas ◽  
Laura K. Lester ◽  
Monica Grazzuitti ◽  
Dirk T. Haselow ◽  
...  
Keyword(s):  
Stem Cell ◽  
Influenza A ◽  
Stem Cell Transplant ◽  
Outpatient Setting ◽  
Case Definition ◽  
Cell Transplant ◽  
Measured Temperature ◽  
Healthcare Provision ◽  
Case Definitions ◽  
Transplant Center

Abstract Background.  In the era of cost-consciousness regarding healthcare , provision of medical services in an outpatient setting has become increasingly attractive. We report an influenza outbreak in an ambulatory stem cell transplant center in 2013 that highlights unique identification and infection control challenges in this setting. Methods.  Nasopharyngeal swabs were performed on patients with suspected influenza-like illnesses (ILI), defined by subjective fever or measured temperature of ≥37.7°C (≥100°F) with cough or sore throat during July 25, 2013 through August 7, 2013. In addition, testing was triggered by an elevated C-reactive protein (CRP). Specimens were analyzed by using eSensor Respiratory Viral Panel. Clinical and epidemiologic information was collected in real time, and frequencies were calculated on demographics, baseline clinical parameters, treatment methods, comorbidities, and symptoms of affected persons. Results.  Thirty-one patients had influenza A (H3N2) infection during July 25, 2013 through August 7, 2013. Only 7 patients (23%) met the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists ILI case definition. Twenty-five patients (81%) had received ≥1 transplant, with 13 (42%) having occurred within 1 year before the outbreak. Twenty-five patients (81%) had received B-cell active chemotherapy &lt;60 days before influenza diagnosis, 6 (19%) were neutropenic, and 25 (81%) lymphopenic. Among clinical and laboratory markers analyzed, abnormal CRP was the most sensitive screening tool for influenza. Twelve (39%) patients were hospitalized (median stay, 10 days; range, 2–20). No deaths occurred. Conclusions.  Immunocompromised hosts with influenza have atypical presentations. Existing surveillance case definitions might be insufficient to reliably identify influenza outbreaks in such patients.

scholarly journals Neoplastic causes of nonacute facial paralysis: A review of 221 cases

2016 ◽  
Vol 95 (9) ◽  
pp. 390-396 ◽  
Author(s):  
John P. Leonetti ◽  
Sam J. Marzo ◽  
Douglas A. Anderson ◽  
Joshua M. Sappington
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Surgical Approaches ◽  
Facial Weakness ◽  
Gradual Onset

We conducted a retrospective review to assess the clinical presentation of patients with tumor-related nonacute complete peripheral facial weakness or an incomplete partial facial paresis and to provide an algorithm for the evaluation and management of these patients. Our study population was made up of 221 patients—131 females and 90 males, aged 14 to 79 years (mean: 49.7)—who had been referred to the Facial Nerve Disorders Clinic at our tertiary care academic medical center over a 23–year period with a documented neoplastic cause of facial paralysis. In addition to demographic data, we compiled information on clinical signs and symptoms, radiologic and pathologic findings, and surgical approaches. All patients exhibited gradual-onset facial weakness or facial twitching. Imaging identified an extratemporal tumor in 128 patients (58%), an infratemporal lesion in 55 patients (25%), and an intradural mass in 38 (17%). Almost all of the extratemporal tumors (99%) were malignant, while 91 % of the infratemporal and intradural tumors were benign. A transtemporal surgical approach was used in the 93 infratemporal and intradural tumor resections, while the 128 extratemporal lesions required a parotidectomy with partial temporal bone dissection. The vast majority of patients (97%) underwent facial reanimation. We conclude that gradual-onset facial paralysis or twitching may occur as a result of a neoplastic invasion of the facial nerve along its course from the cerebellopontine angle to the parotid gland. We caution readers to beware of a diagnosis of “atypical Bell's palsy.”

scholarly journals 1317. Prevalence of Pseudomonas aeruginosa as the Causative Organism for Community Acquired Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S747-S747
Author(s):  
Adam D Haviland ◽  
Wendy Szymczak ◽  
Gregory Weston
Keyword(s):  
Risk Factors ◽  
Influenza A ◽  
Medical Center ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Causative Organism ◽  
Inclusion Criteria ◽  
Term Care ◽  
Empiric Antibiotic ◽  
Antigen Tests

Abstract Background IDSA/ATS guidelines regarding pneumonia diagnosis and treatment changed in 2019. Guidelines recommend determining local prevalence of MRSA and P. aeruginosa to help guide empiric antibiotic coverage. The aim of our study was to determine the prevalence of P. aeruginosa as the causative organism for adult patients admitted to a large urban academic medical center with community acquired pneumonia (CAP). Methods A report of urine streptococcus antigen tests collected January 1st-December 31st in 2019 was generated. Six hundred charts were reviewed and two hundred subjects met inclusion criteria (figure 1). Inclusion criteria were age &gt;18, hospital admission, and documented suspicion of pneumonia by a physician. Results The average age was 70 and half of the cases were women. The causative organism was identified in 60/200 cases (table 1). No cases of P. aeruginosa were identified. The most commonly isolated organisms were Influenza A and pneumococcus. 66% of cases had age &gt;65yo, 25% were from long term care facilities, 34% had structural lung disease, 20% had dementia, 15% were hospitalized in the prior 90 days and received IV antibiotics, and 30% of cases met severe CAP criteria (table 2). Figure 1. Workflow Table 1. Organisms Identified Table 2. Risk Factors Conclusion Limitations include a low prevalence of renal failure in the study population, and lack of a standardized respiratory infection evaluation. Our results suggest that empiric coverage for P. aeruginosa may not be needed at our center in this cohort of older patients with clinical characteristics sometimes thought to be risk factors for P. aeruginosa. Disclosures Wendy Szymczak, PhD, Premier, Inc (Consultant)Qiagen (Consultant, Scientific Research Study Investigator) Gregory Weston, MD MSCR, Allergan (Grant/Research Support)

scholarly journals Viral Culture in Hospitalized Congregate Care Patients With Prolonged SARS-CoV-2 Viral RNA Detection

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 734-735
Author(s):  
Thilaka Arunachalam ◽  
Amit Singh ◽  
Kathleen Stellrecht ◽  
Sarah Elmendorf ◽  
Tarani K Barman ◽  
...  
Keyword(s):  
Viral Load ◽  
Symptom Onset ◽  
Clinical Symptoms ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Viral Rna ◽  
Nasopharyngeal Swab ◽  
Active Virus ◽  
Viral Culture ◽  
Congregate Care

Abstract Prolonged detection of SARS-CoV-2 viral RNA has been observed in hospitalized congregate care patients following resolution of clinical symptoms. It is unknown whether patients with persistent PCR positivity pose a risk for COVID-19 transmission. The purpose of this study was to examine the results of serial PCR testing, viral load, and viral culture in patients awaiting discharge prior to a negative PCR test. We sampled 14 patients who were admitted from skilled nursing and/or rehabilitation facilities to a large academic medical center, had clinical signs and symptoms of COVID-19, and had multiple PCR-positive tests separated by at least 14 days. PCR-positive nasopharyngeal swabs were obtained from each patient for viral load quantification and viral culture. The mean age of patients was 72.5 years (55 – 92), with a mean peak SOFA score of 5.6 (1 – 11). Patients were hospitalized for a mean of 37.0 days (25 – 60). RNA was detected by PCR for a mean of 32.9 days (19 – 47). Mean viral load for the first PCR-positive nasopharyngeal swab collected at our hospital was 5.81 genomic copies/mL (2.12 – 9.72). Viral load decreased significantly with days from clinical symptom onset (R = -0.69, 95% CI, -0.80 – -0.55). Four out of 28 samples grew active virus via culture, with no active virus isolates after 2 days of symptom onset. Our viral culture data suggests that persistent PCR positivity may not correlate with infectivity, which has important implications for COVID-19 infection control precautions among older congregate care patients.

scholarly journals 391. Outcomes of Empiric Antimicrobial Therapy in COVID-19 Positive Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S264-S265
Author(s):  
Corey J Medler ◽  
Lejla Jakupovic ◽  
Allison J Weinmann ◽  
Rachel Kenney ◽  
Susan L Davis ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Status ◽  
Low Frequency ◽  
Drug Effects ◽  
Severity Of Illness ◽  
Patient Characteristics ◽  
Nasopharyngeal Swab ◽  
Cross Sectional ◽  
The Impact

Abstract Background The COVID-19 pandemic has revealed new challenges for antimicrobial stewardship. Optimal medical treatment is not completely understood at this time. The epidemiology and outcomes of bacterial co-infections are not well-established; however, empiric antibiotic (abx) use is anecdotally common. The purpose of this study is to characterize empiric antimicrobial drug selection and timing in COVID-19 and evaluate the impact on patient outcomes. Methods Cross-sectional cohort study for COVID-19 positive inpatients from March 1, 2020 to June 1, 2020 at an academic medical center and 4 community hospitals. Inclusion: patients with a documented positive COVID-19 PCR nasopharyngeal swab. Exclusion: patients less than 18 years; deceased or transitioned to hospice within 24 hours of admission. Primary endpoint: empiric abx drug, initiation, duration and indication. Additional data collected: severity of illness, co-infection diagnosis, microbiology, and adverse drug effects (ADE). Clinical outcomes included time to recovery by COVID-19 ordinal outcome, clinical status at day 15, and readmission. Results 400 patients were included with 27% from the ICU. COVID symptom category included mild (23.8%), moderate (53%), severe (15%), and critical (8.3%). 322 (80.5%) received abx at any time during hospital stay, 301 (93.5%) started within 1 day of admission. Most common documented indication community-acquired pneumonia (69%). Identified 43 (10.8%) microbiologically confirmed co-infections, including 5 MRSA and 7 Pseudomonas. Median duration of initial abx 4 days. 54/322 (16.8%) had abx restarted after discontinuation. Median days to recovery without abx was 10 days (7 – 14) and 14 days (9 – 20) with abx. Patient characteristics and outcomes described in table 1. 74 abx related ADE were identified: gastrointestinal 37 and renal 22. Conclusion It’s difficult to distinguish bacterial and Covid-19 in coinfections in patients ill enough to be hospitalized. Longer courses of empiric abx therapy were prevalent as the severity of illness increased. However, the low frequency of microbiologically confirmed bacterial co-infections results in potentially unnecessary abx exposure. This exposure increases risk of abx ADE and may not improve clinical outcome. Disclosures All Authors: No reported disclosures

scholarly journals Validation of a Community Acquired Pneumonia Score to Improve Empiric Antibiotic Selection at an Academic Medical Center

2020 ◽  
Author(s):  
Meredith B. Oliver ◽  
Karen Fong ◽  
Laura Certain ◽  
Emily S. Spivak ◽  
Tristan T. Timbrook
Keyword(s):  
Risk Factors ◽  
Prediction Models ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Community Acquired Pneumonia ◽  
Drug Resistant ◽  
Clinical Prediction ◽  
Local Risk ◽  
Prior Infection

The 2019 American Thoracic Society and the Infectious Diseases Society of America Community-Acquired Pneumonia (CAP) Guidelines recommend 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 17 adult patients with ICD-10 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 AUROC curve was 0.76 (95% CI, 0.69-0.82). From regression analysis, prior infection with a DRP and antibiotics in the last 60 days, yielding score of 2 and 1 points 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 demonstrates a decreased performance in our patient population and behaves similar to other clinical prediction models. Empiric CAP therapy without anti-MRSA and anti-pseudomonal coverage should be considered for non-critically 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.

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