Risk score-guided treatment for hospitalized pneumonia in older patients.

Background: 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.

Aim: 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.

Methods: 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.

Results: 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.

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