Influencing factors of multidrug-resistant bacterial infection among patients in neurosurgical intensive care unit and construction of a risk prediction nomogram
10.3760/cma.j.issn.1674-2397.2024.04.005
- VernacularTitle:神经外科重症监护病房患者多重耐药菌感染的影响因素分析及诺谟图构建
- Author:
Xuelian ZHOU
1
;
Hongwei YU
;
Yang LI
;
Zhuojun DENG
;
Xiao MIAO
;
Yan XU
Author Information
1. 南京医科大学康达学院第一附属医院神经外科，连云港222000
- Keywords:
Neurosurgery;
Intensive care unit;
Multiple drug resistance;
Nomogram
- From:
Chinese Journal of Clinical Infectious Diseases
2024;17(4):291-296
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors of multidrug-resistant organism（MDRO）infection among patients in neurosurgery intensive care unit（NSICU）and to construct a risk prediction nomogram.Methods:A total of 434 patients admitted in the NSICU of the First Affiliated Hospital of Kangda College of Nanjing Medical University from August 2021 to October 2022 were enrolled in the study. Patients were divided into modeling group（ n=217）and validation group（ n=217）. Multivariate Logistic regression was used to analyze the risk factors of MDRO infection in patients，and R software was used to construct a risk prediction nomogram.The prediction power of the nomogram was evaluated with receiver operating characteristic（ROC）curve，the calibration of the model was assessed with Hosmer-Lemeshow（H-L）goodness-of-fit method. Results:Multivariate Logistic regression analysis showed that the underlying disease≥3（ OR=2.580，95% CI 1.322-5.035），the combination of antimicrobial drugs >10 days（ OR=2.336，95% CI 1.182-4.615），hypoproteinemia（ OR=1.962，95% CI 1.031-3.735），invasive operation time（10-20 d： OR=2.358，95% CI 1.048-5.306；>20 d： OR=3.486，95% CI 1.643-7.395）and GCS≤8 points（ OR=2.961，95% CI 1.470-5.963）were independent risk factors of MDRO infection among patients in NSICU. The area under the curve（AUC）of the nomogram in predicting the risk of MDRO infection for patients in modeling group was 0.787（95% CI 0.725-0.849）with a sensitivity of 73.3% and a specificity of 72.5%，the H-L test results were χ2=7.482， P=0.486，the calibration curve was close to the ideal curve，and the mean absolute error was 0.022. The AUC of the nomogram in predicting MDRO infection for patients in verification group was 0.800（95% CI 0.739-0.861）with a sensitivity of 74.7% and a specificity of 73.9%，the H-L test results were χ2=9.824， P=0.278，the calibration curve was close to the ideal curve，and the average absolute error was 0.015. Conclusion:The nomogram constructed based on the risk factors can effectively predict the risk of MDRO infection for patients in neurosurgical ICU，which may be used in clinic pratcice.
