Risk score-guided treatment for hospitalized pneumonia in older patients

Initial intravenous antibiotic treatment strategy for pneumonia is debated in older people living in nursing homes. Guidelines of the American Thoracic Society identified American Health-Care Associated Pneumonia (HCAP) which covered Nursing Home-Acquired Pneumonia (NHAP) and can be used as a score. The Complicated Pathogen Risk Assessment Score (CPRS) focuses on comorbidities and clinical past history.

This study assesses the usefulness of HCAP score and CPRS in choosing initial empiric therapy while comparing their predictive value for a required change in initial antibiotic regimen and for mortality in hospitalized older patients.

This is a retrospective analysis of 175 patients aged 75 years or more hospitalized for pneumonia from 2014 to 2015. They were treated according to the French guidelines as community-acquired pneumonia. The HCAP score and the CPRS were analyzed retrospectively. They were matched to in-hospital mortality and to change in initial antibiotic regimen rates.

Therapy as recommended for CAP was started in all 175 patients. A change in antibiotic regimen was noted in 17% of patients: 30% of those with a CPR score > 2 and 20% of those with an HCAP score ≥ 1. The global mortality rated 11% for all patients, 20.5% for those with a CPRS score > 2, and 16.5% for those with an HCAP score ≥ 1. Both changes for antibiotic regimen (p < 0.001) and mortality ( p< 0.001) rates were more closely associated with a CPRS  > 2 than with an HCAP score ≥ 1.

Multidrug-resistant risk scores are useful in optimizing initial empirical therapy for NHAP in the elderly.