Catching ‘dangerous bugs’

A new study led by a student from Oakland University William Beaumont School of Medicine suggests there’s a better way to help doctors decide when to give patients strong antibiotics.

“Combining DRIP Score and Rapid Diagnostics for Improved Antibiotic Stewardship,” was led by Richard Ramirez, a fourth-year medical student at OUWB.

Co-authors were Matthew Sims, M.D., Ph.D., associate professor of Internal Medicine at OUWB, and director of Infectious Disease Research, Corewell Health East, and Alemu Fite, Ph.D., an infectious diseases researcher at Corewell Health William Beaumont University Hospital in Royal Oak.

Ramirez and Sims presented the work in Washington, D.C., at IDWeek, the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.

Through the study, the team essentially sought to determine if a better system could be developed for deciding when patients should be treated with broad-spectrum antibiotics, which can be effective, but also carry risks.

“One of the first decisions a clinician has to make is whether or not to put the patient on broad-spectrum antibiotics,” said Ramirez. “It’s a really tough decision.”

Catching ‘dangerous bugs’

Broad-spectrum antibiotics fight against a wide array of disease-causing bacteria. However, broad-spectrum antibiotics also pose specific risks, particularly the disruption of native, normal bacteria, and the potential development of superbugs, or strains of bacteria, viruses, parasites, and fungi that are resistant to most antibiotics.

The study took into account two methods doctors use to help them decide when they should or shouldn’t use the medications.

A Drug Resistance in Pneumonia (DRIP) score is one of the methods used to determine when to use broad-spectrum antibiotics. The score is based on patient answers to several key questions on factors such as if the patient has been on antibiotics in the last 60 days, any other current medications, and so on.

“The DRIP score is a very simple way to say ‘This patient likely needs broad-spectrum antibiotics,’ or ‘This patient likely doesn’t need broad-spectrum anti-biotics,’” said Sims.

The problem, said Ramirez, is that using the DRIP score to determine use of the anti-biotics can lead to patients taking strong antibiotics they may not need.

“You can have a patient who needs one very simple drug taking three or four different ones,” he said.

Enter the other method used by doctors to determine when to use a broad-spectrum antibiotics regimen: a Unyvero Lower Respiratory Tract Infection (LRTI) panel.

An LRTI is a newer rapid diagnostic tool that can determine within hours exactly what bugs a patient has, which allows doctors to know if they should use broad-spectrum anti-biotics, or if they can use less.

An LRTI also finds specific pathogens and resistances that require antibiotics beyond vancomycin and anti-pseudomonals.

The problem with LRTI panels, however, is that they are very expensive. Not only that, but they are too often used on patients found not to have pneumonia.

As Sims told Contagion Live, the costs and higher number of negatives put doctors in the tough position of having to decide when to roll the dice and use LRTI panels.

“What we wanted to do was look at how do we improve this…to make it more likely that the people you use (LRTI panels) on are the right people,” he said.

The study led by Ramirez looked at aggregate data from 442 patients who participated in the LRTI panel clinical trial locally.

Ramirez said that by looking at the data, the team was able to develop an algorithm that essentially would qualify patients for an LRTI panel if their DRIP score meets a certain threshold.

“To hospitals, what we’re saying is that if you use the DRIP score to stratify patients that use the more expensive (LRTI panel) on, you will catch the vast majority of dangerous bugs and be able to treat them specifically within hours instead of having a patient unnecessarily on all these extra drugs for multiple days,” said Ramirez.

‘An amazing experience’

Ramirez led the study through OUWB’s Embark program.

Embark is a required scholarly concentration program that provides a mentored introduction to research and scholarship. The four-year longitudinal curriculum consists of structured coursework in research design and implementation, compliance training, research communication, and scholarly presentation, with protected time to develop mentored projects in a wide-range of community and health-related settings.

Ramirez said he enjoyed being part of the research project from the start, which will help him in the future.

“I got to really get an idea of the complexity of getting a study started, filling out all the paperwork, getting down to the nuts and bolts of how to present data, and how to validate data,” he said. “It was very eye-opening.”

Being able to present the work at IDWeek, he said, was “an incredible experience.”

“It was amazing,” he said. “You have all the leaders in the field there…names you see in all of the papers and now you’re there among them. Just incredible.”