TY - JOUR
T1 - Validation of the prediction rules identifying drug-resistant pathogens in community-onset pneumonia
AU - Central Japan Lung Study Group
AU - Kobayashi, Daisuke
AU - Shindo, Yuichiro
AU - Ito, Ryota
AU - Iwaki, Mai
AU - Okumura, Junya
AU - Sakakibara, Toshihiro
AU - Yamaguchi, Ikuo
AU - Yagi, Tetsuya
AU - Ogasawara, Tomohiko
AU - Sugino, Yasuteru
AU - Taniguchi, Hiroyuki
AU - Saito, Hiroshi
AU - Saka, Hideo
AU - Kawamura, Takashi
AU - Hasegawa, Yoshinori
N1 - Funding Information:
Dr Shindo reports receiving personal fees from Pfizer Inc, Shionogi & Co, Ltd, Beckman Coulter, Inc, MSD KK, Dainippon Sumitomo Pharma Co, Ltd, and Taisho Toyama Pharmaceutical Co, Ltd. Dr Yagi reports receiving grants from Taisho Toyama Pharmaceutical Co, Ltd, Shionogi & Co, Ltd, Pfizer Inc, Daiichi Sankyo Co, Ltd, Meiji Seika Pharma Co, Ltd, Astellas Pharma Inc, Dainippon Sumitomo Pharma Co, Ltd, and MSD KK; and receiving personal fees from Taisho Toyama Pharmaceutical Co, Ltd, Shionogi & Co, Ltd, Pfizer Inc, Asahi Kasei Pharma Co, Ltd, Daiichi Sankyo Co, Ltd, Meiji Seika Pharma Co, Ltd, Astellas Pharma Inc, Dainippon Sumitomo Pharma Co, Ltd, MSD KK, and Mitsubishi Tanabe Pharma. Dr Ogasawara reports receiving personal fees from Chugai Pharmaceutical Co, Ltd, Japan Boehringer Ingelheim Co, Ltd, Taiho Pharmaceutical Co, Ltd, Bristol-Myers Squibb Inc, Kyowa Hakko Kirin Pharmaceutical Co, Ltd, and KYORIN Pharmaceutical Co, Ltd. Dr Sugino reports receiving personal fees from Astellas Pharma Inc, Ono Pharmaceutical Co, Ltd, Shionogi & Co, Ltd, Chugai Pharmaceutical Co, Ltd, Abbott Japan Co, Ltd, MSD KK, Sanofi, GlaxoSmithKline plc, Mitsubishi Tanabe Pharma, Pfizer Inc, Novartis Pharma KK, AstraZeneca KK, KYORIN Pharmaceutical Co, Ltd, and Elsevier Japan KK. Dr Taniguchi reports receiving personal fees from Abbott Japan Co, Ltd, Actelion Pharmaceuticals Japan Ltd, Asahi Kasei Pharma Corp, Astellas Pharma Inc, AstraZeneca KK, Bayer in Japan, Boehringer Ingelheim Co, Ltd, Chugai Pharmaceutical Co, Ltd, Eli Lilly Japan KK, Fukuda Denshi Co, Ltd, GlaxoSmithKline plc, KYORIN Pharmaceutical Co, Ltd, Meiji Seika Pharma Co, Ltd, Novartis Pharma KK, Ono Pharmaceutical Co, Ltd, Pfizer Japan Inc, Philips Res-pironics GK, Shionogi & Co, Ltd, TAIHO Pharmaceutical Co, Ltd, Terumo Corporation, and Teijin Pharma Ltd. Dr Saito reports receiving grants from Ono Pharmaceutical Co, Ltd, Taiho Pharmaceutical Co, Ltd, and Merck Serono Co, Ltd; and receiving personal fees from Ono Pharmaceutical Co, Ltd, Pfizer Inc, Astrazeneca KK, and Kyowa Hakko Kirin Co, Ltd. Dr Saka reports receiving grants from Taisho Toyama Pharmaceutical Co, Ltd, Shionogi & Co, Ltd, Pfizer Inc, Chugai Pharmaceutical Co, Ltd, Dainippon Sumitomo Pharma Co, Ltd, Bristol-Myers Squibb Company, Kyowa Hakko Kirin Co, Ltd, Eisai Co, Ltd, Ono Pharmaceutical Co, Ltd, Boehringer Ingelheim Co, Ltd, MSD KK, Eli Lilly Japan KK, Daiichi Sankyo Co, Ltd, Astrazeneca KK, Novartis Pharma KK, Taiho Pharmaceutical Co, Ltd, Sanofi KK, and Bayer Yakuhin, Ltd. Dr Kawamura reports receiving personal fees from Sanofi KK. Dr Hasegawa reports receiving grants from Chugai Pharmaceutical Co, Ltd, Daiichi Sankyo Co, Ltd, Astellas Pharma Inc, Dainippon Sumitomo Pharma Co, Ltd, and MSD KK; and receiving personal fees from Taisho Toyama Pharmaceutical Co, Ltd, Shionogi & Co, Ltd, Pfizer Inc, Chugai Pharmaceutical Co, Ltd, Daiichi Sankyo Co, Ltd, Astellas Pharma Inc, Dainippon Sumitomo Pharma Co, Ltd, MSD KK, Meiji Seika Pharma Co, Ltd, and Abbott Japan Co, Ltd. The other authors report no conflicts of interest in this work.
Funding Information:
We thank the laboratory staff (Mariko Mochizuki, Yoshiko Sugaki, Yusuke Nishida, Sachie Asai, and Nobuya Saka-gami), and all health care professionals who participated in the data collection. Funders of the Central Japan Lung Study Group (CJLSG) had no role in the design and conduct of the study; gathering, management, analysis, and interpretation of data; and preparation of the manuscript. This study was supported by JSPS KAKENHI grant number JP17K09610 and by CJLSG, a nonprofit organization supported by unrestricted donations from the following pharmaceutical
Publisher Copyright:
© 2018 Kobayashi et al.
PY - 2018
Y1 - 2018
N2 - Background: Appropriate initial antibiotic treatment and avoiding administration of unnecessary broad-spectrum antibiotics are important for the treatment of pneumonia. To achieve this, assessment of risk for drug-resistant pathogens (DRPs) at diagnosis is essential. Purpose: The aim of this study was to validate a predictive rule for DRPs that we previously proposed (the community-acquired pneumonia drug-resistant pathogen [CAP-DRP] rule), comparing several other predictive methods. Patients and methods: A prospective observational study was conducted in hospitalized patients with community-onset pneumonia at four institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin–sulbactam, macrolides, and respiratory fluoroqui-nolones were defined as CAP-DRPs. Results: CAP-DRPs were identified in 73 (10.1%) of 721 patients analyzed. The CAP-DRP rule differentiated low vs high risk of CAP-DRP at the threshold of ≥3 points or 2 points plus any of methicillin-resistant Staphylococcus aureus specific factors with a sensitivity of 0.45, specificity of 0.87, positive predictive value of 0.47, negative predictive value of 0.87, and accuracy of 0.79. Its discrimination performance, area under the receiver operating characteristic curve, was 0.73 (95% confidence interval 0.66–0.79). Specificity of the CAP-DRP rule against CAP-DRPs was the highest among the six predictive rules tested. Conclusion: The performance of the predictive rules and criteria for CAP-DRPs was limited. However, the CAP-DRP rule yielded high specificity and could specify patients who should be treated with non-broad-spectrum antibiotics, eg, a non-pseudomonal β-lactam plus a macrolide, more precisely.
AB - Background: Appropriate initial antibiotic treatment and avoiding administration of unnecessary broad-spectrum antibiotics are important for the treatment of pneumonia. To achieve this, assessment of risk for drug-resistant pathogens (DRPs) at diagnosis is essential. Purpose: The aim of this study was to validate a predictive rule for DRPs that we previously proposed (the community-acquired pneumonia drug-resistant pathogen [CAP-DRP] rule), comparing several other predictive methods. Patients and methods: A prospective observational study was conducted in hospitalized patients with community-onset pneumonia at four institutions in Japan. Pathogens identified as not susceptible to ceftriaxone, ampicillin–sulbactam, macrolides, and respiratory fluoroqui-nolones were defined as CAP-DRPs. Results: CAP-DRPs were identified in 73 (10.1%) of 721 patients analyzed. The CAP-DRP rule differentiated low vs high risk of CAP-DRP at the threshold of ≥3 points or 2 points plus any of methicillin-resistant Staphylococcus aureus specific factors with a sensitivity of 0.45, specificity of 0.87, positive predictive value of 0.47, negative predictive value of 0.87, and accuracy of 0.79. Its discrimination performance, area under the receiver operating characteristic curve, was 0.73 (95% confidence interval 0.66–0.79). Specificity of the CAP-DRP rule against CAP-DRPs was the highest among the six predictive rules tested. Conclusion: The performance of the predictive rules and criteria for CAP-DRPs was limited. However, the CAP-DRP rule yielded high specificity and could specify patients who should be treated with non-broad-spectrum antibiotics, eg, a non-pseudomonal β-lactam plus a macrolide, more precisely.
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U2 - 10.2147/IDR.S165669
DO - 10.2147/IDR.S165669
M3 - Article
AN - SCOPUS:85057606438
VL - 11
SP - 1703
EP - 1713
JO - Infection and Drug Resistance
JF - Infection and Drug Resistance
SN - 1178-6973
ER -