第三代头孢菌素耐药大肠埃希菌血流感染风险预测模型的建立及验证  

Construction and validation of the prediction model for the bloodstream infection caused by third-generation cephalosporin-resistant Escherichia coli

作　　者：刘春林 陈萍[1] 杜燕娇 吴清念 蔡甜 LIU Chun-lin;CHEN Ping;DU Yan-jiao;WU Qing-nian;CAI Tian(Department of Laboratory Medicine,The Sixth Affiliated Hospital,South China University of Technology,Foshan 528200,China)

机构地区：[1]华南理工大学附属第六医院检验科,广东佛山528200

出　　处：《中国感染控制杂志》2023年第2期136-141,共6页Chinese Journal of Infection Control

基　　金：广东省医学科研基金项目(B2021428)。

摘　　要：目的建立第三代头孢菌素耐药(3GCR)大肠埃希菌血流感染预测模型并验证。方法回顾性选取2014年1月—2021年12月某医院大肠埃希菌血流感染患者494例作为研究对象,其中434例作为建模组,60例作为验证组,依据是否对第三代头孢菌素(头孢噻肟)耐药,将研究对象分成3GCR组和第三代头孢菌素敏感(3GCS)组。记录研究对象临床资料、实验室结果,logistic回归分析筛选独立危险因素,构建列线图,并验证模型准确性。结果logistic回归分析显示,侵入性操作(OR=19.482,95%CI:11.434~33.194)、使用头孢菌素(OR=1.843,95%CI:1.070~3.173)、高水平降钙素原(OR=1.272,95%CI:1.159~1.396)和高水平C反应蛋白(OR=1.006,95%CI:1.002~1.011)是发生3GCR大肠埃希菌血流感染的独立危险因素。据此建立列线图模型,Hosmer-Lemeshouw法显示建模组P=0.562,验证组P=0.742,该模型有较好的拟合度。列线图在建模组和验证组的受试者工作特征(ROC)曲线下面积分别为0.883(95%CI:0.851~0.914)、0.857(95%CI:0.807~0.907),显示该模型有较好的区分度。决策曲线分析显示该预测模型价值较高。结论基于侵入性操作、使用头孢菌素、PCT和CRP水平的预测模型区分是否为3GCR菌株具有一定的实用价值。Objective To construct and validate the prediction model for the third-generation cephalosporin-resis-tant(3GCR)Escherichia coli(E.coli)bloodstream infection.Methods 494 patients with E.coli bloodstream infection in a hospital from January 2014 to December 2021 were selected as studied subjects,of which 434 cases were divided as the modeling group and 60 cases as the validation group.According to 3GCR resistance,subjects were classified into the 3GCR group and the third-generation cephalosporin sensitive(3GCS)group.Clinical data and laboratory results of the subjects were recorded,and the independent risk factors were screened by logistic regression analysis.Nomogram was constructed to validate the accuracy of the model.Results Logistic regression analysis showed that invasive operation(OR=19.482,95%CI:11.434-33.194),use of cephalosporin(OR=1.843,95%CI:1.070-3.173),high level procalcitonin(OR=1.272,95%CI:1.159-1.396)and high level C-reactive protein(CRP,OR=1.006,95%CI:1.002-1.011)were independent risk factors for 3GCR E.coli bloodstream infection.Nomograph model was constructed.The Hosmer-Lemeshow method showed good fitting results of the model with the modeling group P=0.562 and the validation group P=0.742.The area under the receiver operating characteristic(ROC)curve of the modeling group and validation group were 0.883(95%CI:0.851-0.914)and 0.857(95%CI:0.807-0.907)respectively,indicating that the model has good discrimination.The decision curve analysis showed that the prediction model was of high value.Conclusion The predictive model based on invasive manipulation,use of cephalosporins,PCT and CRP levels has certain practical value in distinguishing 3GCR strain.

关 键 词：第三代头孢菌素耐药 大肠埃希菌 血流感染 风险预测模型 

分 类 号：R181.3[医药卫生—流行病学] R378.21[医药卫生—公共卫生与预防医学]