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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 fluoroquinolones 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. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background and objective: Drug‐resistant pathogen (DRP) risk stratification is important for choosing a treatment strategy for community‐onset pneumonia. Evidence for benefits of non‐antipseudomonal β‐lactam plus macrolide combination therapy (BLM) on mortality is limited in patients at low DRP risk. Risk factors for mortality remain to be clarified. Methods: Post hoc analysis using a prospective multicentre study cohort of community‐onset pneumonia was performed to assess 30‐day differences in mortality between non‐antipseudomonal β‐lactam monotherapy (BL) and BLM groups. Logistic regression analysis was performed to assess the therapeutic effect and risk factors for mortality in patients at low DRP risk. Results: In total, 594 patients with community‐onset pneumonia at low DRP risk (369 BL and 225 BLM) were analysed. The 30‐day mortality in BL and BLM was 13.8% and 1.8%, respectively (P < 0.001). Multivariate analysis showed that BLM reduced the 30‐day mortality (adjusted odds ratio: 0.28, 95% CI: 0.09–0.87) compared with BL. Independent prognostic factors for 30‐day mortality included arterial partial pressure of carbon dioxide (PaCO2) > 50 mm Hg, white blood cell count < 4000/mm3, non‐ambulatory status, albumin < 3.0 g/dL, haematocrit < 30%, age ≥ 80 years, respiratory rate > 25/min and body temperature < 36°C. Conclusion: In patients with community‐onset pneumonia at low DRP risk, BLM treatment reduced 30‐day mortality compared with BL. Independent risk factors for mortality are potential confounding factors when assessing antibiotic effects in randomized clinical trials. [ABSTRACT FROM AUTHOR]