预测住院患者获得耐碳青霉烯类铜绿假单胞菌医院感染的列线图模型的构建
|
摘要
目的探讨住院患者获得耐碳青霉烯类铜绿假单胞菌(Carbapenem-Resistant Pseudomonas aeruginosa,CRPA)医院感染的影响因素,并构建列线图风险预测模型。方法回顾性分析2014年1月1日-2018年1月7日入住温州市人民医院的发生铜绿假单胞菌医院感染的180例患者的临床资料,在多因素Logistic回归分析结果基础上建立预测住院患者获得CRPA医院感染的列线图模型。结果多因素Logistic回归分析显示,患者年龄、Charlson合并症指数评分、感染前30d内使用碳青霉烯类抗菌药物以及机械通气治疗是发生CRPA医院感染的独立影响因素;根据回归系数(β)建立的评分模型如下:Logistic(P)=-2.01+1.03×(Charlson合并症指数评分>4分=1)+1.16×(感染前30d内使用碳青霉烯类抗菌药物=1)+1.18×(年龄≥65岁=1)+1.46×(机械通气治疗=1);利用R软件绘制的列线图,其初始一致性指数(C-index)为0.802,经1000次的模型内部验证后一致性指数(C-index)为0.797。结论基于上述4个影响因素构建的列线图能较为准确预测住院患者获得CRPA医院感染的风险。
OBJECTIVE To investigate the influencing factors for nosocomial infection caused by carbapenems-resistant Pseudomonas aeruginosa in hospitalized patients,and to construct a clinical nomogram risk prediction model.METHODS The clinical data of 180 patients with P aeruginosa-related nosocomial infections who were admitted to Wenzhou People's Hospital from Jan.1 st,2014 to Jan.7 th,2018 were retrospectively analyzed.A nomogram model for predicting nosocomial infection caused by carbapenems-resistant P aeruginosain hospitalized patients was developed on the results of the multivariate logistic regression analysis.RESULTS Multivariate logistic regression analysis showed that patients' age,Charlson comorbidity index score,use of carbapenems within 30 days prior to infection,and treatment with mechanical ventilation were independent influencing factors of P aeruginosa-related HAI.The scoring model developed based on the regression coefficient(β)was as the following:Logistic(P)=-2.01+1.03*(Charlson comorbidity index score higher than 4 points=1)+1.16*(use of carbapenems within 30 days prior to infection=1)+1.18*(age of 65 years old or above=1)+1.46*(treatment with mechanical ventilation= 1).The nomogram was established with R statistical software.The initial concordance index(C-index)of the nomogram was 0.802,and the C-index of the nomogram was 0.797 after 1000 times of internal validation.CONCLUSIONThe nomogram constructed based on the above-mentioned four influencing factors could accurately predict the risk of nosocomial infection caused by carbapenems-resistant P aeruginosain hospitalized patients.
OBJECTIVE To investigate the influencing factors for nosocomial infection caused by carbapenems-resistant Pseudomonas aeruginosa in hospitalized patients,and to construct a clinical nomogram risk prediction model.METHODS The clinical data of 180 patients with P aeruginosa-related nosocomial infections who were admitted to Wenzhou People's Hospital from Jan.1 st,2014 to Jan.7 th,2018 were retrospectively analyzed.A nomogram model for predicting nosocomial infection caused by carbapenems-resistant P aeruginosain hospitalized patients was developed on the results of the multivariate logistic regression analysis.RESULTS Multivariate logistic regression analysis showed that patients' age,Charlson comorbidity index score,use of carbapenems within 30 days prior to infection,and treatment with mechanical ventilation were independent influencing factors of P aeruginosa-related HAI.The scoring model developed based on the regression coefficient(β)was as the following:Logistic(P)=-2.01+1.03*(Charlson comorbidity index score higher than 4 points=1)+1.16*(use of carbapenems within 30 days prior to infection=1)+1.18*(age of 65 years old or above=1)+1.46*(treatment with mechanical ventilation= 1).The nomogram was established with R statistical software.The initial concordance index(C-index)of the nomogram was 0.802,and the C-index of the nomogram was 0.797 after 1000 times of internal validation.CONCLUSIONThe nomogram constructed based on the above-mentioned four influencing factors could accurately predict the risk of nosocomial infection caused by carbapenems-resistant P aeruginosain hospitalized patients.
引文
[1]Liu Q,Li X,Li W,et al.Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosainfection:a meta-analysis[J].Sci Rep,2015,5:11715.
[2]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[3]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:twentysecond informational supplement.CLSI document M02-A11-M07-A9[S].Wayne(PA):Clinical and Laboratory Standards Institute;2012.
[4]Lee CH,Su TY,Ye JJ,et al.Risk factors and clinical significance of bacteremia caused by Pseudomonas aeruginosa resistant only to carbapenems[J].J Microbiol Immunol Infect,2017,50(5):677-683.
[5]Khadem T,Stevens V,Holt K,et al.Risk factors for carbapenem-nonsusceptible Pseudomonas aeruginosa:casecontrol study[J].Diagn Microbiol Infect Dis,2017,89(2):146-150.
[6]罗赛赛,郑巧伟,董亚琳,等.我院2013-2016年耐碳青霉烯类铜绿假单胞菌医院感染的危险因素与临床结局分析[J].中国药房,2018,29(5):667-670.
[7]Quiles MG,Carlesse F,da Silva MA,et al.High mortality outbreak of carbapenem-resistant,Pseudomonas aeruginosa,infection in a Brazilian pediatric oncology hospital[J].Braz J Infect Dis,2017,21(2):205-206.
[8]Lin KY,Lauderdale TL,Wang JT,et al.Carbapenem-resistant Pseudomonas aeruginosain Taiwan:prevalence,risk factors,and impact on outcome of infections[J].J Microbiol Immunol Infect,2016,49(1):52-59.
[9]Mao CC,Chen XD,Lin J,et al.A novel nomogram for predicting postsurgical intra-abdominal infection in gastric cancer patients:aprospective study[J].J Gastrointest Surg,2018,22(3):421-429.
[10]Voor In't Holt AF,Severin JA,Lesaffre EM,et al.A systematic review and meta-analyses show that carbapenem use and medical devices are the leading risk factors for carbapenem-resistant Pseudomonas aeruginosa[J].Antimicrob A-gents Chemother,2014,58(5):2626-2637.
[11]Dantas RC,Ferreira ML,Gontijo-Filho PP,et al.Pseudomonas aeruginosa bacteremia:independent risk factors for mortality and impact of resistance on outcome[J].J Med Microbiol,2014,63(12):1679-1687.
[12]Al-Agamy MH,Jeannot K,El-Mahdy TS,et al.Diversity of molecular mechanisms conferring carbapenem resistance to Pseudomonas aeruginosaisolates from Saudi Arabia[J].Can J Infect Dis Med Microbiol,2016,2016:4379686.
[13]Rossi Goncalves I,Dantas RCC,Ferreira ML,et al.Carbapenem-resistant Pseudomonas aeruginosa:association with virulence genes and biofilm formation[J].Braz J Microbiol,2017,48(2):211-217.
[2]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[3]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:twentysecond informational supplement.CLSI document M02-A11-M07-A9[S].Wayne(PA):Clinical and Laboratory Standards Institute;2012.
[4]Lee CH,Su TY,Ye JJ,et al.Risk factors and clinical significance of bacteremia caused by Pseudomonas aeruginosa resistant only to carbapenems[J].J Microbiol Immunol Infect,2017,50(5):677-683.
[5]Khadem T,Stevens V,Holt K,et al.Risk factors for carbapenem-nonsusceptible Pseudomonas aeruginosa:casecontrol study[J].Diagn Microbiol Infect Dis,2017,89(2):146-150.
[6]罗赛赛,郑巧伟,董亚琳,等.我院2013-2016年耐碳青霉烯类铜绿假单胞菌医院感染的危险因素与临床结局分析[J].中国药房,2018,29(5):667-670.
[7]Quiles MG,Carlesse F,da Silva MA,et al.High mortality outbreak of carbapenem-resistant,Pseudomonas aeruginosa,infection in a Brazilian pediatric oncology hospital[J].Braz J Infect Dis,2017,21(2):205-206.
[8]Lin KY,Lauderdale TL,Wang JT,et al.Carbapenem-resistant Pseudomonas aeruginosain Taiwan:prevalence,risk factors,and impact on outcome of infections[J].J Microbiol Immunol Infect,2016,49(1):52-59.
[9]Mao CC,Chen XD,Lin J,et al.A novel nomogram for predicting postsurgical intra-abdominal infection in gastric cancer patients:aprospective study[J].J Gastrointest Surg,2018,22(3):421-429.
[10]Voor In't Holt AF,Severin JA,Lesaffre EM,et al.A systematic review and meta-analyses show that carbapenem use and medical devices are the leading risk factors for carbapenem-resistant Pseudomonas aeruginosa[J].Antimicrob A-gents Chemother,2014,58(5):2626-2637.
[11]Dantas RC,Ferreira ML,Gontijo-Filho PP,et al.Pseudomonas aeruginosa bacteremia:independent risk factors for mortality and impact of resistance on outcome[J].J Med Microbiol,2014,63(12):1679-1687.
[12]Al-Agamy MH,Jeannot K,El-Mahdy TS,et al.Diversity of molecular mechanisms conferring carbapenem resistance to Pseudomonas aeruginosaisolates from Saudi Arabia[J].Can J Infect Dis Med Microbiol,2016,2016:4379686.
[13]Rossi Goncalves I,Dantas RCC,Ferreira ML,et al.Carbapenem-resistant Pseudomonas aeruginosa:association with virulence genes and biofilm formation[J].Braz J Microbiol,2017,48(2):211-217.