Knowledge of the determinant factors responsible for the presence of antimicrobial-resistant pathogens in severe nursing home acquired pneumonia (NHAP) is deemed essential for antibiotic selection.
During a 36-month period, all cases of institutionalized patients with confirmed severe pneumonia by protected bronchoalveolar lavage (≥103 CFU/ml) were analyzed. A classification tree was developed with a sensitivity of 100% by binary recursive partitioning to predict those patients who are unlikely to have DRP related pneumonia.
Of the 88 patients who satisfied the inclusion criteria, 17 had at least one drug-resistant pathogen (DRP) recovered from the lower respiratory tract. The predictor variables were Activity of Daily Living score and prior use of antibiotics. Prospective application of the model in 47 patients over 24 month yielded a sensitivity of 100% (95% CI 71.3%–100%) and 69.4% specificity (95% CI 51.9%–83.6%).
The use of the tree may provide a more rational basis for selecting initial therapy for severe NHAP.
the classification tree can be used as a guideline for health care providers in clinical decision making that optimizes the use of antimicrobial therapy and minimizes the emergence of drug resistant bacteria in intensive care settings.
A.A. El Solh, None.