多重耐药鲍曼不动杆菌医院感染危险因素预测模型的构建

A nomogram risk prediction model for patients with nosocomial infection of multidrug-resistant Acinetobacter baumannii

目的分析多重耐药鲍曼不动杆菌(multidrug-resistant acinetobacter baumannii,MDRAB)医院感染危险因素,并建立列线图预测模型。方法采用回顾性分析方法,收集2022年7月至2023年7月149例鲍曼不动杆菌(acinetobacter baumannii,AB)医院感染患者临床资料,根据是否发生MDRAB感染分为多重耐药组43例和非多重耐药组106例。比较2组临床资料的差异,采用多因素logistic回归分析MDRAB医院感染危险因素,以筛选危险因素为指标建立列线图预测模型,并对模型预测效果进行内部验证。结果多因素logistic回归结果显示,年龄(OR=0.960,95%CI=0.916~1.006)、住院时间(OR=0.681,95%CI=0.528~0.877)、低蛋白血症(OR=3.862,95%CI=1.132~3.173)、气管插管/切开(OR=3.935,95%CI=1.255~2.335)、抗菌药使用>3种(OR=2.645,95%CI=0.944~1.410)是MDRAB医院感染的独立危险因素(均P<0.05)。列线图预测模型的C指数为0.823(95%CI:0.748~0.896),预测MDRAB医院感染的曲线下面积为0.892,敏感性为76.7%,特异性为90.6%。结论年龄、住院时间、低蛋白血症、气管插管/切开、抗菌药使用>3种是MDRAB医院感染的独立危险因素,基于危险因素构建的列线图预测模型有利于医护人员快速筛查相关危险因素,及时采取相应的防治措施。

Objective To analysis the risk factor for patients with nosocomial infection of multidrug-resistant Acinetobacter baumannii(MDRAB)and to establish a nomogram model to predict the risk of infection.Methods Clinical data of consecutive 149 patients with nosocomial infection of Acinetobacter baumannii from July 2022 to July 2023 were retrospectively collected.According to the multidrug resistance or not,they were assigned to MDR group(n=43)and non-MDR group(n=106).Clinical data of two groups were compared.Risk factors for nosocomial infection of MDRAB were analyzed by multivariate logistic regression.A nomogram was established based on the risk factors,and validated for its performance by an internal validation.Results Multivariate logistic regression demonstrated that age(OR=0.960,95%CI=0.916-1.006),hospital stay(OR=0.681,95%CI=0.528-0.877),hypoproteinemia(OR=3.862,95%CI=1.132-3.173),tracheal intubation/incision(OR=3.935,95%CI=1.255-2.335),and types of antibacterial drugs>3(OR=2.645,95%CI=0.944-1.410)were independent risk factors for predicting nosocomial infection of MDRAB(all P<0.05).The C-index of nomogram model based on the above risk factors was 0.823(95%CI=0.748-0.896),with the area under the curve of 0.892,specificity of 76.7%and sensitivity of 90.6%.Conclusion Age,hospital stay,hypoproteinemia,tracheal intubation/incision,and types of antibacterial drugs>3 are independent risk factors for predicting nosocomial infection of MDRAB.A nomogram based on risk factors is useful for clinicians to screen for related risk factors and take corresponding measures.