重症监护病房患者多重耐药菌感染的危险因素分析和列线图模型评价

Risk factors analysis and nomogram model evaluation of multi-drug resistant organism infection in intensive care unit patients

目的分析重症监护病房(ICU)患者多重耐药菌(MDRO)感染的危险因素,构建列线图模型并评价模型预测拟合效果。方法收集2020年1月至2022年12月四川省人民医院905例ICU患者的临床资料进行回顾性分析。依据患者是否发生MDRO感染,将患者分为MDRO感染组(303例)和非MDRO感染组(602例)。对收集的患者相关资料进行单因素及多因素Logistic回归分析。利用R4.3.1软件构建MDRO感染风险的列线图模型,并通过受试者工作特征曲线和校准曲线评价模型的预测拟合效果。结果多因素Logistic回归分析结果显示,男性、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、混合感染、呼吸衰竭、慢性呼吸系统疾病、神经系统疾病、有创机械通气时间、胃管插管、使用碳青霉烯类抗菌药物、使用第三代头孢菌素、使用四环素类抗菌药物是ICU患者MDRO感染的独立危险因素(均P<0.05)。基于Logistic回归分析结果构建的列线图模型,受试者工作特征曲线下面积为0.849,95%置信区间:0.823~0.874,Hosmer-Lemeshow检验显示χ^(2)=139.69,P=0.332,且校准曲线预测发生率与实测发生率之间偏差小,模型校准度好、预测拟合效果好。结论男性、APACHEⅡ评分、一些合并症、胃管插管、使用某些抗菌药物等因素是ICU患者MDRO感染的独立危险因素。基于危险因素构建的列线图风险预测模型具有良好的预测能力,可以为及时采取预防性感染控制措施提供参考。

Objective To analyze the risk factors of multi-drug resistant organism(MDRO)infection in intensive care unit(ICU)patients,construct a nomogram model,and evaluate the prediction and fitting effect of the model.Methods The clinical data of 905 ICU patients in Sichuan Provincial People′s Hospital from January 2020 to December 2022 were collected and retrospectively analyzed.The patients were divided into MDRO infection group(303 cases)and non-MDRO infection group(602 cases)according to whether MDRO infection occurred.Univariate and multivariate Logistic regression analysis were used to analyze the relevant data of the patients.R4.3.1 software was used to construct a nomogram model of MDRO infection risk,and the receiver operating characteristic curve and calibration curve were used to evaluate the prediction and fitting effect of the model.Results Multivariate Logistic regression analysis showed that male,acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)score,mixed infection,respiratory failure,chronic respiratory disease,nervous system disease,invasive mechanical ventilation time,gastric tube intubation,use of carbapenem antibiotics,use of the third generation cephalosporins,and use of tetracycline antibiotics were independent risk factors for MDRO infection in ICU patients(all P<0.05).The nomogram model based on the results of Logistic regression analysis had an area under the receiver operating characteristic curve of 0.849 and 95%confidence interval of 0.823-0.874.The Hosmer-Limeshow test showed thatχ^(2)=139.69,P=0.332.The deviation between the predicted and measured incidence of the calibration curve was small,and the model calibration was good and the prediction fitting effect was good.Conclusions Male,APACHEⅡscore,some complications,gastric tube intubation,use of some antibiotics and other factors were independent risk factors for MDRO infection in ICU patients.The nomogram risk prediction model based on risk factors has good predictive ability,which can provide reference for timely preventive infection control measures.