重症监护病房耐碳青霉烯类肺炎克雷伯菌感染预测模型的构建

Risk factors of carbapenem-resistant Klebsiella pneumoniae infection in ICU patients and construction of a prediction model for infection

目的分析重症监护病房(Intensive care unit,ICU)耐碳青霉烯类肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae,CRKP)感染的危险因素,并构建CRKP感染预测模型。方法收集济宁市第一人民医院2020年1月至2022年12月ICU的肺炎克雷伯菌感染患者资料,并进行回顾性分析,将2020年1月至2021年12月收治的患者作为建模组(n=150),2022年1至12月收治的患者作为验证组(n=54),建模组基于对碳青霉烯类药物的敏感性分为CRKP组(n=59)和碳青霉烯类敏感肺炎克雷伯菌组(Carbapenem-sensitive Klebsiella pneumonia,CSKP,n=91),采用多因素Logistic回归分析CRKP感染的危险因素,并构建CRKP感染预测模型,通过受试者工作特征曲线评估模型预测价值,并通过验证组数据对上述模型进行验证。结果多因素Logistic回归分析显示,经验性使用β-内酰胺类药物(OR=6.985,95%CI 1.658~29.423,P=0.008)、中心静脉置管(OR=7.486,95%CI 2.776~20.186,P<0.001)和气管插管/切开(OR=10.695,95%CI 2.701~42.351,P=0.001)为ICU患者CRKP感染的危险因素。CRKP感染预测模型回归方程=-4.851+经验性使用β-内酰胺类药物×1.944+中心静脉置管×2.013+气管插管/切开×2.370,该模型预测建模组CRKP感染的曲线下面积(AUC)为0.905,敏感度为79.7%,特异度为90.1%,预测验证组CRKP感染的AUC为0.881,敏感度为84.2%,特异度为85.7%。结论基于经验性使用β-内酰胺类药物、中心静脉置管和气管插管/切开构建的预测模型对ICU患者CRKP感染情况具有较好的预测价值。

Objective To analyze the risk factors of carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in intensive care unit(ICU)patients and to construct a prediction model for infection.Methods The clinical data of 204 patients with Klebsiella pneumoniae infection admitted in ICU of Jining First Hospital during January 2020 to December 2022 were retrospectively analyzed.Patients admitted during January 2020 to December 2021 were selected as model set(n=150),and patients admitted during January to December 2022 were selected as validation set(n=54).In model set,there were 59 cases infected with CRKP(CRKP group)and 91 cases infected with carbapenem-sensitive Klebsiella pneumonia(CSKP group).The risk factor of CRKP infection in ICU patients were analyzed with multivariate Logistic regression,based on which an infection prediction model was constructed.The predictive value of the model was evaluated by ROC,and verified in the validation group.Results Multivariate Logistic regression analysis showed that empirical use of beta-lactam antibiotics(OR=6.985,95%CI 1.658-29.423,P=0.008),central vein catheterization(OR=7.486,95%CI 2.776-20.186,P<0.001)and tracheal intubation/incision(OR=10.695,95%CI 2.701-42.351,P=0.001)were risk factors for CRKP infection in ICU patients.The regression equation for predicting the risk of infection was-4.851+empirical use of beta-lactam antibiotics×1.944+central vein catheterization×2.013+tracheal intubation/incision×2.370.The area under the ROC curve(AUC)of the model for predicting infection in the model group was 0.905,with sensitivity and specificity of 79.7%and 90.1%,respectively.The AUC of the model for predicting infection in validation group was 0.881,with sensitivity and specificity of 84.2%and 85.7%,respectively.Conclusion The constructed infection prediction model in the study can effectively predict CRKP infection in ICU patients.