title: Application of a Risk Score to Identify Older Adults with Community-Onset Pneumonia Most Likely to Benefit From Empiric Pseudomonas Therapy.
abstract: To assess the impact of empiric Pseudomonas pharmacotherapy on 30-day mortality in hospitalized patients with community-onset pneumonia stratified according to their risk (low, medium, or high) of drug-resistant pathogens.
  
  
  
  Retrospective cohort study.
  
  
  
  Veterans Health Administration database.
  
  
  
  A total of 50,119 patients who were at least 65 years of age, hospitalized with pneumonia, and received antibiotics within 48 hours of admission between fiscal years 2002 and 2007. Patients were stratified into empiric Pseudomonas therapy (31,027 patients) and no Pseudomonas therapy (19,092 patients) groups based on antibiotics received during their first 48 hours of admission.
  
  
  
  A clinical prediction scoring system developed in 2014 that stratifies patients with community-onset pneumonia according to their risk of drug-resistant pathogens was used to identify patients who were likely to benefit from empiric Pseudomonas therapy as well as those in whom antipseudomonal therapy could be spared; patients were classified into low-risk (68%), medium-risk (21%), and high-risk (11%) groups. Of the 50,119 patients, 62% received Pseudomonas therapy. All-cause 30-day mortality was the primary outcome. Empiric Pseudomonas therapy (adjusted odds ratio 0.72, 95% confidence interval 0.62-0.84) was associated with lower 30-day mortality in the high-risk group but not the low- or medium-risk groups.
  
  
  
  Application of a risk score for patients with drug-resistant pathogens can identify patients likely to benefit from empiric Pseudomonas therapy. Widespread use of this score could reduce overuse of anti-Pseudomonas antibiotics in low- to medium-risk patients and improve survival in high-risk patients.
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.|South Texas Veterans Health Care System, San Antonio, Texas.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Frei
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rehani
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Grace C
authors.initials: GC
authors.lastname: Lee
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Natalie K
authors.initials: NK
authors.lastname: Boyd
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Erene
authors.initials: E
authors.lastname: Attia
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pechal
authors.affiliation: Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.|Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Britt
authors.affiliation: VA North Texas Health Care System, Dallas, Texas.|The University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000900:Anti-Bacterial Agents
keywords: evidence-based medicine; infectious disease; outcomes; pharmacy practice; pulmonary