Mathematical examination of dual individualization principles. (III): Development of a scoring system for pneumonia staging and quantitation of response to antibiotics: results in cefmenoxime-treated patients.
OBJECTIVE
In order to quantitatively express the important, time-related aspects of response to antimicrobial therapy in patients with pneumonia, we required validated measures of the time course of events during the infection. To quantitate the changes in clinical status in relation to changes in cultures, we developed a scoring system to be used for patient assessment during therapy.


METHODS
Retrospective data collection, prospective analysis of factors.


METHODS
Intensive care unit, Millard Fillmore Hospital.


METHODS
Twenty-eight patients with nosocomial pneumonia.


METHODS
Clinical parameters were assessed daily for the duration of antimicrobial therapy. Using linear regression, the rate of clinical change in each patient treated was quantified. Eradication of the pathogen was determined by serial cultures of the infection site.


RESULTS
Seventeen of the patients demonstrated eradication of the organism, and 11 demonstrated persistence of the pathogen (7 were considered colonization). The system described the patients at baseline in that the mean baseline scores were similar in both groups of patients (p = 0.79). Patients in whom the pathogen was eradicated showed a rate of clinical improvement significantly different from those who had persistence of the organism (p = 0.04). In patients demonstrating eradication, the time to eradication inversely correlated with the rate of clinical improvement (p < 0.05). Of the ten parameters descriptive of the disease, those most sensitive to change after eradication of bacteria were body temperature, bacterial Gram stain, white blood cell Gram stain, and volume of sputum.


CONCLUSIONS
In this set of pneumonia patients, the scoring system effectively quantified both baseline and time-related changes in clinical status. The system distinguished between the clinical course of the patient with organism eradication versus organism persistence. A shorter time to eradication was associated with a better clinical response. Prospective study of the system will determine its sensitivity.
Luzier
A
A
Clinical Pharmacokinetics Laboratory, Millard Filmore Hospital, Buffalo, NY 14209.
Goss
T F
TF
Cumbo
T J
TJ
Schentag
J J
JJ
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015281:Cefmenoxime / Q000627:therapeutic use*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000145:classification / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D011014:Pneumonia / Q000145:classification / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D015281:Cefmenoxime