{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T14:41:10Z","timestamp":1761489670268,"version":"3.37.3"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,5,20]],"date-time":"2015-05-20T00:00:00Z","timestamp":1432080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["KL2 TR000446","K23AI104779","K23HL102069","UL1 TR000445"],"award-info":[{"award-number":["KL2 TR000446","K23AI104779","K23HL102069","UL1 TR000445"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Six recently published algorithms classify pneumonia patients presenting from the community into high\u2010 and low\u2010risk groups for resistant bacteria. Our objective was to compare performance of these algorithms for identifying patients infected with bacteria resistant to traditional community\u2010acquired pneumonia antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study of consecutive adult patients diagnosed with pneumonia in an emergency department and subsequently hospitalized. Each patient was classified as high or low risk for resistant bacteria according to the following algorithms: original health care\u2013associated pneumonia (<jats:styled-content style=\"fixed-case\">HCAP<\/jats:styled-content>) criteria, Summit criteria, Brito and Niederman strategy, Shorr model, Aliberti model, and Shindo model. The reference for comparison was detection of resistant bacteria, defined as methicillin\u2010resistant <jats:italic>Staphylococcus aureus<\/jats:italic> or Gram\u2010negative bacteria resistant to ceftriaxone or levofloxacin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 614 patients were studied, including 36 (5.9%) with resistant bacteria. The <jats:styled-content style=\"fixed-case\">HCAP<\/jats:styled-content> criteria classified 304 (49.5%) patients as high risk, with an area under the receiver operating characteristic curve (<jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>) of 0.63 (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0=\u00a00.54 to 0.72), sensitivity of 0.69 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a00.52 to 0.83), and specificity of 0.52 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a00.48 to 0.56). None of the other algorithms improved both sensitivity and specificity or significantly improved the <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>. Compared to the <jats:styled-content style=\"fixed-case\">HCAP<\/jats:styled-content> criteria, the Shorr and Aliberti models classified more patients as high risk, resulting in higher sensitivity and lower specificity. The Shindo model classified fewer patients as high risk, with lower sensitivity and higher specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>All algorithms for identification of resistant bacteria included in this study had suboptimal performance to guide antibiotic selection. New strategies for selecting empirical antibiotics for community\u2010onset pneumonia are necessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12672","type":"journal-article","created":{"date-parts":[[2015,5,21]],"date-time":"2015-05-21T02:42:29Z","timestamp":1432176149000},"page":"730-740","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Comparison of Clinical Prediction Models for Resistant Bacteria in Community\u2010onset Pneumonia"],"prefix":"10.1111","volume":"22","author":[{"given":"Wesley H.","family":"Self","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University School of Medicine Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"Wunderink","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University School of Medicine Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler W.","family":"Barrett","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University School of Medicine Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrienne H.","family":"Baughman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University School of Medicine Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos G.","family":"Grijalva","sequence":"additional","affiliation":[{"name":"Department of Health Policy Vanderbilt University School of Medicine Nashville TN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,5,20]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1","article-title":"Deaths: final data for 2005","volume":"56","author":"Kung HC","year":"2008","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12203"},{"key":"e_1_2_7_4_1","unstructured":"Agency for Healthcare Research and Quality.Pneumonia most common reason for hospitalization. Available at:http:\/\/archive.ahrq.gov\/news\/nn\/nn070208.htm. Accessed Mar 10 2015."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200405-644ST"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/148.5.1418"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.153.5.8630626"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-137-10-200211190-00007"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.6.3854"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1185\/030079904125004376"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1562"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis022"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-006-0197-9"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000240789.93764.0F"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/526355"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e328329fa4e"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit571"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.20.2205"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir813"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir840"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201301-0079OC"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(96)70264-0"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201308-1536ED"},{"volume-title":"Cumitech 7A","year":"1978","author":"Bartlett JG","key":"e_1_2_7_25_1"},{"key":"e_1_2_7_26_1","unstructured":"BD Phoenix Laboratory Procedure. Available at:https:\/\/www.bd.com\/ds\/technicalCenter\/clsi\/clsi-Phoenix_GramNegative_V5.15_V4.31.pdf. Accessed Mar 13 2015."},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199701233360402"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit734"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7458.168"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.12.009"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-2434"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.115.2.462"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076225"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dks475"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.07.005"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70314-5"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38028.520995.63"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199401273300406"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp0804651"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkf009"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1086\/664910"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00141110"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit578"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit738"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Facem.12672","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.12672","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T12:26:44Z","timestamp":1696336004000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.12672"}},"subtitle":[],"editor":[{"given":"Brian J.","family":"O'Neil","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2015,5,20]]},"references-count":45,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2015,6]]}},"alternative-id":["10.1111\/acem.12672"],"URL":"https:\/\/doi.org\/10.1111\/acem.12672","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"type":"print","value":"1069-6563"},{"type":"electronic","value":"1553-2712"}],"subject":[],"published":{"date-parts":[[2015,5,20]]},"assertion":[{"value":"2014-08-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-12-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-05-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}