Utilizing Rapid Diagnostics and DRIP Scores Together to Tailor Therapy and Enhance Stewardship

Traditionally, when caring for patients with pneumonia, clinicians may be inclined to use broad-spectrum antibiotics for coverage, which can lead to overtreatment.

Clinicians have used the Drug Resistance in Pneumonia (DRIP) tool to aid in predicting cases of bacterial pneumonia that prove resistant to antibiotics, but it can, in some cases, still lead to some use of broad-spectrum antibiotics and over coverage.

The use of rapid diagnostics has been an emerging part of medicine, and Matthew Sims, MD, PhD, director of Infectious Disease Research, Corewell Health East, explains his institution was an early adopter of the rapid diagnostic the Unyvero Lower Respiratory Tract Panel (LRTP).

He also says that utilizing such technology alone can lead to many negatives and be quite expensive for institutions. Therefore, he would like to see this testing be used a little more judiciously and it is important to find the right patients for it.

So, Sims and his coinvestigator, medical student Richard Ramirez, wanted to look at combining the two tools to see if they could improve diagnosis and tailor antibiotic treatment by creating an algorithm.  

“Using an existing patient pool from a clinical trial of the LRTP a DRIP score was determined for each patient. When data elements of the DRIP score were unavailable a DRIPmax and DRIPmin were calculated assuming all missing elements were positive or negative respectively,” Sims and his coinvestigator wrote about their methods. “The sensitivity and specificity of the DRIP score vs culture and LRTP were determined. An algorithm for antibiotic selection based on the results of the DRIP score combined with the LRTP was applied to each patient.”

Sims sat down to talk with Contagion to discuss the study’s results in the subsequent poster, “Combining DRIP Score and Rapid Diagnostics for Improved Antibiotic Stewardship,” which he presented at ID Week 2022.

“What we found is that if you use just the DRIP score as your initial cut and we’re going to run the [LRTP] panel on patients who have a score of four or more—which is the cutoff—you catch almost everyone who has a drug-resistant pathogen,” Sims stated.

Sims saw great utility in combining both tools when warranted in their study. “You really get incredible antibiotic stewardship from the panel and we used the DRIP score to give us diagnostic stewardship.”

In talking with Contagion, Sims discussed the study’s results, some interesting takeaways in thinking about antibiotic coverage, what pathogens they were able to catch in combining the two tools together, and the importance of time to optimal therapy in the right patients.