重症监护室患者多重耐药菌感染危险因素分析及列线图预测模型构建与验证  

Analysis of risk factors for multidrug-resistant bacterial infections in intensive care unit patients and development and validation of a nomogram prediction model

作　　者：王珂璇 金晓灵[1] 祁琪 茅一萍 WANG Kexuan;JIN Xiaoling;Qi Qi;MAO Yiping(Hepatobiliary and Pancreatic Center of Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu 21009,China;Department of Infection Management,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004)

机构地区：[1]东南大学附属中大医院肝胆胰中心,江苏南京210009 [2]徐州医科大学附属医院感染管理科,江苏徐州221004

出　　处：《徐州医科大学学报》2025年第3期196-201,共6页Journal of Xuzhou Medical University

基　　金：国家卫生健康委医院管理研究所科研课题(GY2023023-A)。

摘　　要：目的探讨重症监护室患者多重耐药菌感染的危险因素,构建列线图预测模型并进行验证。方法回顾性分析徐州医科大学附属医院2019年6月—2023年6月入住重症监护室患者946例,根据是否发生多重耐药菌感染分为病例组及对照组,收集患者相关临床资料,使用SPSS26.0对数据进行logistic回归分析,筛选出重症监护室患者感染多重耐药菌的独立危险因素,使用R软件在回归分析的基础上建立预测模型,使用一致性指数、受试者工作特征曲线下面积、霍斯默-莱梅肖检验评价模型。结果患者从门诊或外院转院入院、长期入住重症监护室、手术、无肺部感染、恶性肿瘤、外周静脉置管、插引流管、低凝血酶时间、高白细胞介素6、抗菌药物使用种类≥3种、抗菌药物使用时长<1周是重症监护室患者感染多重耐药菌的独立危险因素。根据以上指标构建重症监护室患者感染多重耐药菌列线图预测模型,模型验证结果显示一致性指数为0.915,受试者工作特征曲线下面积为0.915,霍斯默-莱梅肖检验P>0.05,模型区分度及准确度良好。结论重症监护室患者感染多重耐药菌危险因素较多,利用该因素构建列线图模型具有较好的临床价值,可为预防患者发生多重耐药菌感染提供临床指导。Objective To explore the risk factors for multidrug-resistant(MDR)bacterial infections in intensive care unit(ICU)patients and to develop and validate a nomogram prediction model.Methods A retrospective analysis was conducted on 946 ICU patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from June 2019 to June 2023.Based on whether they developed MDR bacterial infections,the patients were divided into a case group and a control group.Their clinical data were collected,and logistic regression analysis was performed using SPSS 26.0 to identify independent risk factors for MDR bacterial infections in ICU patients.Based on the regression analysis,a prediction model was developed using R software.The model was evaluated using the concordance index(C-index),area under the receiver operating characteristic(ROC)curve,and the Hosmer-Lemeshow test.Results Independent risk factors for MDR bacterial infections in ICU patients included admission through outpatient or inter-hospital transfer,prolonged ICU stay,surgery,absence of pulmonary infection,presence of malignant tumors,peripheral venous catheterization,drainage tube insertion,prolonged thrombin time,elevated interleukin-6 levels,use of≥3 types of antibiotics,and antibiotic use duration of less than one week.Based on these factors,a nomogram prediction model for MDR bacterial infections in ICU patients was constructed.Model validation showed a C-index of 0.915,an area under the ROC curve of 0.915,and a Hosmer-Lemeshow test result of P>0.05,indicating good discrimination and accuracy.Conclusions ICU patients are at high risk for MDR bacterial infections due to multiple risk factors. The nomogram prediction model constructedbased on these factors has significant clinical value and can provide guidance for preventing MDR bacterial infectionsin ICU patients.

关 键 词：重症监护室 多重耐药菌 危险因素 列线图 预测模型 感染 

分 类 号：R473.1[医药卫生—护理学]