耐碳青霉烯类肺炎克雷伯菌血流感染危险因素分析及列线图预测模型构建

Analysis of risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection and construction of a nomogram prediction model

目的 探究住院患者发生耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)血流感染的危险因素,并构建列线图模型。方法 选取2016年1月1日—2021年12月31日我院药学部收治的190例肺炎克雷伯菌(Klebsiella pneumonia, KP)所致血流感染患者作为研究对象,并根据是否耐碳青霉烯类抗菌药物,分为CRKP组(n=40)和碳青霉烯类敏感肺炎克雷伯菌(carbapenem-sensitive Klebsiella pneumonia, CSKP)组(n=150)。Logistic回归模型分析住院患者发生CRKP血流感染的危险因素,并绘制预测CRKP血流感染的列线图模型。使用ROC曲线、校准曲线及HosmerLemeshow(H-L)检验对列线图模型进行验证。结果 感染前1个月内留置导尿管、留置中心静脉导管、使用免疫抑制剂、使用碳青霉烯类抗菌药物以及年龄≥65岁是影响住院患者发生CRKP血流感染的危险因素(P均<0.05)。对列线图进行验证,校准曲线拟合良好,H-L检验χ~2=7.630,P=0.366,AUC为0.817(95%CI:0.739~0.895)。结论 感染前1个月内留置导尿管、留置中心静脉导管、使用免疫抑制剂、使用碳青霉烯类抗菌药物以及年龄≥65岁是住院患者发生CRKP血流感染的危险因素,据此构建的列线图模型对住院患者发生CRKP所致血流感染有较好预测价值,可为临床医护人员制定个体化防治策略提供参考。

Objective To investigate the risk factors of carbapenem-resistant Klebsiella pneumonia(CRKP) bloodstream infection in hospitalized patients, and to construct a nomogram model. Methods A total of 190 patients with bloodstream infection caused by Klebsiella pneumoniae(KP) admitted to the department of pharmacy of our hospital from January 1, 2016 to December 31, 2021 were selected as the research subjects. Accordingto the carbapenem resistance, they were divided into CRKP group(n=40) and carbapenemsensitive Klebsiella pneumoniae(CSKP) group(n=150). Logistic regression model was used to analyze the risk factors of CRKP bloodstream infection in hospitalized patients, and a nomogram model for predicting CRKP bloodstream infection was drawn. ROC curve, calibration curve and Hosmer-Lemeshow(H-L) test are used to verify the nomogram model. Results Indwelling urinary catheter, indwelling central venous catheter, use of immunosuppressants, use of carbapenem antibiotics, and age ≥ 65 years were the risk factors for CRKP bloodstream infection in hospitalized patients within 1 month before infection(P <0.05). The nomogram was verified, and the calibration curve fit well,H-L test χ~2=7.630, P=0.366, and the AUC was 0.817(95% CI: 0.739 ~ 0.895). Conclusions Indwelling urinary catheter, indwelling central venous catheter, use of immunosuppressants, use of carbapenem antibiotics, and age ≥ 65 years were the risk factors for CRKP bloodstream infection in hospitalized patients within 1 month before infection. The nomogram model constructed on this basis has a hign predictive value for CRKP bloodstream infection in hospitalized patients, and can provide reference for clinical medical staff to formulate individualized prevention and treatment strategiy.