title: Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia.
abstract: BACKGROUND
  Knowledge of the determinant factors responsible for the presence of antimicrobial-resistant pathogens in severe nursing home-acquired pneumonia (NHAP) is deemed essential for antibiotic selection.
  
  
  METHODS
  Data for institutionalized patients with cases of severe pneumonia confirmed by culture of protected bronchoalveolar lavage fluid samples (> or =10(3) cfu/mL) during a 36-month period were analyzed. A classification tree with a sensitivity of 100% was developed using binary recursive partitioning to predict which patients are unlikely to have drug-resistant pathogen (DRP)-related pneumonia.
  
  
  RESULTS
  Of the 88 patients who satisfied the inclusion criteria, 17 had at least 1 DRP recovered from the lower respiratory tract. The predictor variables were the Activity of Daily Living score and previous use of antibiotics. Prospective application of the model in 47 patients over a 24-month period yielded a sensitivity of 100% (95% confidence interval [CI], 71.3%-100%) and a specificity of 69.4% (95% CI, 51.9%-83.6%).
  
  
  CONCLUSIONS
  The use of the tree may provide a more rational basis for selecting initial therapy for severe NHAP after it is validated in a large prospective study.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Erie County Medical Center, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 14215, USA. solh@buffalo.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: El Solh
authors.forename: Celestino
authors.initials: C
authors.lastname: Pietrantoni
authors.forename: Abid
authors.initials: A
authors.lastname: Bhat
authors.forename: Milapchand
authors.initials: M
authors.lastname: Bhora
authors.forename: Eileen
authors.initials: E
authors.lastname: Berbary
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000627:therapeutic use; D001419:Bacteria / Q000254:growth & development; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006707:Homes for the Aged; D006785:Hospitals, University; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000000981:diagnostic imaging / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000201:enzymology; D008297:Male; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011446:Prospective Studies; D011859:Radiography
chemical_list: D000900:Anti-Bacterial Agents