耐多黏菌素和碳青霉烯类肺炎克雷伯菌感染风险预测模型构建  

Establishment of risk prediction model for polymyxin-and carbapenem-resistant Klebsiella pneumoniae infection

作　　者：贺侠琴 刘梦 张祎[1] 王晓倩 王伟琦 王晓琴[1] HE Xiaqin;LIU Meng;ZHANG Yi;WANG Xiaoqian;WANG Weiqi;WANG Xiaoqin(The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 71006l,Chin)

机构地区：[1]西安交通大学第一附属医院检验科,陕西西安710061

出　　处：《中华医院感染学杂志》2025年第5期776-781,共6页Chinese Journal of Nosocomiology

基　　金：陕西省重点研发计划基金资助项目(2022SF-243);陕西省自然科学基础研究计划基金资助项目(S2024-JC-QN-0771)。

摘　　要：目的分析耐多黏菌素和碳青霉烯类肺炎克雷伯菌(PR-CRKP)感染的危险因素,并构建预测模型。方法回顾性收集西安交通大学第一附属医院2023年1月-2024年3月耐碳青霉烯类肺炎克雷伯菌(CRKP)感染患者的临床资料,依据多黏菌素B药敏结果分为CRKP组和PR-CRKP组,2023年1-12月收治的患者作为建模组(n=203),2024年1-3月收治的患者作为验证组(n=91)。采用多因素logistic回归分析PR-CRKP感染的危险因素,采用R软件构建预测PR-CRKP感染的nomogram图,采用受试者工作特征(ROC)曲线评价模型预测效能。结果单因素分析结果显示,PR-CRKP组患者纤维支气管镜检查、气管插管/切开、合并其他碳青霉烯类耐药菌(CRO)感染、入住重症监护病房(ICU)、血流感染、入院前3个月多黏菌素类和碳青霉烯类抗菌药物暴露史比例均高于CRKP组(P<0.05),住院天数、多黏菌素和碳青霉烯类抗菌药物使用时间均长于CRKP组(P<0.05)。多因素logistic回归分析显示,合并其他CRO感染、入院前3个月多黏菌素类、碳青霉烯类抗菌药物暴露史、多黏菌素类抗菌药物使用时间和入住ICU是PR-CRKP感染的危险因素(P<0.05);建模组预测模型的曲线下面积(AUC)为0.898,敏感度为80.33%,特异度为84.51%。验证组ROC曲线显示AUC值为0.901,敏感度为75.00%,特异度为92.73%。结论本研究根据多因素分析结果构建的预测模型对PR-CRKP感染具有较好的预测价值。OBJECTIVE To explore the risk factors for polymyxin-and carbapenem-resistant Klebsiella pneumoniae(PR-CRKP)infection and establish the prediction model.METHODS The clinical data were retrospectively collected from the patients with CRKP infection who were treated in the First Affiliated Hospital of Xi′an Jiaotong University from Jan.2023 to Mar.2024.The enrolled patients were divided into the CRKP group and the PR-CRKP group according to the result of drug susceptibility testing for polymyxin B.Totally 203 patients who were treated from Jan.2023 to Dec.2023 were assigned as the modeling group,and 91 patients who were treated from Jan.2024 to Mar.2024 were assigned as the validation group.Multivariate logistic regression analysis was performed for the risk factors for PR-CRKP infection,nomogram was built up for prediction of PR-CRKP infection by R software,and the predictive efficacy of the model was evaluated by means of receiver operating characteristic(ROC)curves.RESULTS The result of univariate analysis showed that the proportions of patients who received fiberobronchoscopy,endotracheal intubation/tracheotomy,were complicated with other carbapenem-resistant organisms(CROs)infections,bloodstream infections,were treated in intensive care unit(ICU)and had the history of exposure to polymyxins and carbapenems 3 months before the admission were higher in the PR-CRKP group than in the CRKP group(P<0.05);the length of hospital stay and duration of use of polymyxins and carbapenems were longer in the PR-CRKP group than in the CRKP group(P<0.05).Multivariate logistic regression analysis indicated that complication with other CROs infections,history of exposure to polymyxins and carbapenems 3 months before the admission,duration of use of polymyxins and ICU stay were the risk factors for the PR-CRKP infection(P<0.05).The area under the curve(AUC)of the predictive model was 0.898 in the modeling group,with the sensitivity 80.33%,the specificity 84.51%.ROC curve analysis showed that the AUC was 0.901 in the validation g

关 键 词：多黏菌素耐药 耐碳青霉烯肺炎克雷伯菌 风险预测模型 危险因素 抗菌药物 

分 类 号：R515[医药卫生—内科学]