Drug Resistance in Pneumonia (DRIP) Score
Why Use
More predictive of drug resistant pathogens compared to HCAP and may have the potential to decrease antibiotic over-utilization in pneumonia. Decreases use of unnecessary extended-spectrum antibiotics by 38% as compared with the HCAP definition ( Webb 2019 ). At a cut-off of ≥4 points, DRIP optimally differentiates high and low risk (PPV of 73.0, NPV 92.0, AUROC 0.88, accuracy of 87%), supporting its utility as a clinical decision tool to guide empiric antibiotic selection. Accuracy was defined as “percent of cases in which antibiotic spectrum (that would have been recommended based on DRIP classification) would have been appropriate for the recovered organism.”
When to Use
Patients with community acquired pneumonia.
Formula
Pearls / Pitfalls
Should be utilized only for bacterial causes of pneumonia. False negatives can be seen in the following situations: MRSA or P. aeruginosa infection, severe COPD (requiring O₂ and steroids), IV drug use, psychiatric conditions, and homelessness. False positives can be seen with S. pneumoniae and MSSA. The DRIP validation study evaluated a broader set of risk factors than the HCAP definition. The DRIP study reaffirmed that antibiotic use and hospitalization 60 days prior are major contributors to drug resistance, but did not find a strong association between severity of illness and drug resistance.
Management
A patient with a DRIP Score <4 can effectively be treated without broad-spectrum antibiotic coverage. A patient with a DRIP Score of ≥4 is more likely to require broad-spectrum antibiotic coverage.
Advice
The goal of the DRIP Score is to determine when broad spectrum antibiotics should be used, both to be effective with treatment and to avoid increasing antibiotic resistance.
More Information
Interpretation: DRIP Score Interpretation <4 Low risk of drug-resistant pneumonia. Consider treating without extended-spectrum antibiotics. ≥4 High risk of drug-resistant pneumonia. Extended-spectrum antibiotics likely necessary.