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RATIONALE Drug resistance in pneumonia (DRIP) score, among other prediction models, performed significantly better in detecting the risk of pneumonia due to drug-resistant pathogens (DRP). The use of this clinical prediction score may have the potential to decrease the use of unwarranted extended spectrum antibiotics in patients with low risk of pneumonia due to DRP. Furthermore, It can likewise select patients who will benefit from broad-spectrum antibiotics as initial therapy for patients with high risk of community acquired pneumonia due to DRP (CAP-DRP). This study was initiated to validate its efficiency in the local setting. METHODS This is a single center cross-sectional study. Adult Filipino patients aged 18 years and above who were clinically diagnosed with CAP were included. DRIP score was performed within 48 hours of admission to patients admitted for CAP. A score of <4 was classified as low risk and a score of ≥ 4 was classified as high risk. Confirmation of the presence of DRP was done through review of microbiologic cultures. RESULTS A total of 195 patients were included. DRIP score identified patients at high or low risk of pneumonia due to DRP with a sensitivity of 62.1 (95% CI, 48.4 to 74.5), a specificity of 81% (95% CI, 73.4 to 87.2), a positive predictive value of 58.1% (95% CI, 44.8 to 70.5), and a negative predictive value of 83.5% (95% CI, 76, 89.4). The prevalence of pneumonia due to DRP was 29.7%. Pseudomonas aeruginosa was identified in 15 (7.14%) of patients and was the most common isolated DRP. Tube feeding (OR 5.24), prior infection with DRP (OR 4.47), and hospitalization within previous 60 days (OR 2.52) were identified to be the strongest risk factors associated with pneumonia due to DRP. A modified DRIP score (mDRIP) was derived by eliminating one of the major risk factors, which is residence in a long-term care facility. mDRIP has a sensitivity of 62.07%, specificity of 82.02%, positive likelihood ratio of 3.27 and negative likelihood ratio of 0.47. CONCLUSION This prospective study validated the performance of DRIP score in predicting pneumonia due to DRP. DRIP Score, as well as the modified DRIP score (mDRIP), are valuable prediction models that can be used in the local setting to possibly lessen unnecessary use and therefore preserve the utilization of broadspectrum antibiotics among low risk patients. Future studies are necessary to establish definitive benefit on patient outcome measures.

Background The performance of transcatheter aortic valve replacement (TAVR) has expanded considerably during the past decade. Technological advances and refinement in implantation techniques have resulted in improved procedural outcomes, whereas indications are progressively extending toward lower-risk patients. Ischemic/embolic complications and major bleeding remain important and strongly correlate to mortality. In this regard, the optimal antithrombotic regimen after successful transcatheter aortic valve replacement remains unclear. Purpose To compare the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) for post Transcatheter Aortic Valve Replacement. Search strategy Key Terms: transcatheter aortic valve replacement, transcatheter aortic valve implantation, antiplatelet, single antiplatelet therapy, dual antiplatelet therapy. Selection criteria Four randomized, controlled clinical trials comparing single antiplatelet therapy versus dual antiplatelet therapy for post TAVR patients were included in this study. Method Extensive search of PubMed, Medline, Cochrane and Ovid was done for articles published until November 20, 2020. Studies were limited to RCTs comparing SAPT and DAPT among patients who underwent TAVR. Outcome measures include: stroke, myocardial infarction, all-cause mortality and major bleeding. Two reviewers independently reviewed the studies. Results were gathered from published articles, journals and clinical trials. Studies were critically appraised with regards to methods of minimizing bias. All four studies included received a quality scale for meta-analysis overall score of not less than B. Statistical analysis was done using Review manager V5.4. Main results Four RCTs with 1086 patients were included in this meta-analysis. Overall, the risk of stroke (OR 0.94 [0.54 −1.64]), myocardial infarction (OR 0.50 [0.18–1.40]), and overall mortality (OR 1.01 [0.65–1.57]) did not differ significantly between DAPT and SAPT. There was noted increased risk of bleeding noted with DAPT, thus favoring SAPT (OR 0.44 [0.30–0.65]). Author's conclusions Among patients who underwent TAVR, DAPT compared to SAPT had similar rates of stroke, myocardial infarction and death. Due to lower rates of bleeding, we recommend using single antiplatelet therapy after TAVR. FUNDunding Acknowledgement Type of funding sources: None.