231 - Impact of DRIP Score Documentation at Time of Physician Order Entry on Combination Antimicrobials in Treatment of Community Acquired Pneumonia

Background: The Drug Resistance in Pneumonia (DRIP) score is a predictive model for identifying drug-resistant pathogens in community-acquired pneumonia (CAP). The Detroit Medical Center adopted DRIP documentation at time of antimicrobial order entry for CAP in 2017. The purpose of this study was to identify the difference in overall consumption of antibiotics used for the treatment of CAP after the implementation of DRIP documentation.

Methods: A retrospective analysis of adult patients with an antimicrobial order with a documented indication of pneumonia between Jun 1-Oct 31, 2017 and Jun 1-Oct 31, 2018, was conducted. Days of antimicrobial therapy per 1000 adjusted patient days (DOT/1000 pt days) was assessed in patients before and after implementation of DRIP documentation at time of order entry.  The percent concordance with institutional guidelines for empiric CAP treatment post-implementation of DRIP documentation was also evaluated.

Results: The DOT/1000 pt days increased in the post-DRIP group for ceftriaxone (36.5 vs. 76.3), doxycycline (22.3 vs. 44.5), and azithromycin (29.5 vs. 53.4). The DOT/1000 pt days decreased for carbapenems in the post-DRIP group (14.0 vs. 8.5).  There was no change in vancomycin or linezolid use. Empiric therapy after implementation of DRIP documentation was concordant with institutional guidelines in 34.7% and 11.2% of patients with documented DRIP< 4 and DRIP≥4, respectively. Overall, the most common reason for non-concordance was lack of atypical coverage. Use of expanded Gram-negative coverage (i.e. cefepime) for documented DRIP< 4, and lack of expanded Gram-negative coverage with aminoglycosides in ICU patients with documented DRIP≥4 were also common

Conclusion: An increase in guideline-directed therapy and a decrease in use of carbapenems were seen after implementation of DRIP score documentation at time of order entry.  Overall concordance with guidelines was low, and additional review is needed to identify if providers are accurately documenting the DRIP score. Future directions should focus on education of clinicians on the importance of accurate DRIP documentation in order to improve compliance with institutional guidelines.