Wang Yue, Lin Qun, Chen Zhongju, Hou Hongyan, Shen Na, Wang Zhen, Wang Feng, Sun Ziyong
Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Infect Drug Resist. 2021 Mar 2;14:815-824. doi: 10.2147/IDR.S286401. eCollection 2021.
To establish a risk prediction model for carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in intestinal carriers.
CRE screenings were performed every two weeks in hematology department and intensive care unit (ICU). Patients with positive CRE rectal swab screening were identified using electronic medical records from 15 May 2018 to 31 December 2019. Intestinal carriers who developed CRE BSI were compared with those who did not develop CRE infection. A 1:1 matched case-control study was conducted. The control group was selected by stratified random sampling based on the department to ensure that all the departments were represented. Univariate logistic analysis, multivariate logistic analysis and stepwise regression analysis were carried on a variety of patient factors and microbial factors.
A total of 42 cases were included. Multivariate analysis showed that gastrointestinal injury (OR 86.819, 95% CI 2.584-2916.592, =0.013), tigecycline exposure (OR 14.991, 95% CI 1.816-123.737, =0.012) and carbapenem resistance score (OR 11.236, 95% CI 1.811-69.700, =0.009) were independent risk factors for CRE BSI in intestinal carriers (<0.050). They were included in the Logistic regression model to predict BSI. According to receiver operating characteristic (ROC) curve analysis, the cut-off value of the model was 0.722, and the sensitivity, specificity and area under the curve (AUC) were 90.5%, 85.7% and 0.921, respectively.
The risk prediction model based on gastrointestinal injury, tigecycline exposure and carbapenem resistance score of colonizing strain can effectively predict CRE BSI in patients with CRE colonization. Early CRE screening and detection for inpatients in key departments may promote early warning and reduce the risk of nosocomial infection of CRE.
建立肠道携带者耐碳青霉烯类肠杆菌科细菌（CRE）血流感染（BSI）的风险预测模型。
在血液科和重症监护病房（ICU）每两周进行一次CRE筛查。利用2018年5月15日至2019年12月31日的电子病历识别CRE直肠拭子筛查呈阳性的患者。将发生CRE BSI的肠道携带者与未发生CRE感染的携带者进行比较。开展1:1匹配的病例对照研究。对照组通过基于科室的分层随机抽样选取，以确保所有科室都有代表。对各种患者因素和微生物因素进行单因素逻辑回归分析、多因素逻辑回归分析和逐步回归分析。
共纳入42例病例。多因素分析显示，胃肠道损伤（比值比[OR]86.819，95%置信区间[CI]2.584 - 2916.592，P = 0.013）、替加环素暴露（OR 14.991，95% CI 1.816 - 123.737，P = 0.012）和碳青霉烯耐药评分（OR 11.236，95% CI 1.811 - 69.700，P = 0.009）是肠道携带者发生CRE BSI的独立危险因素（P < 0.050）。将它们纳入逻辑回归模型以预测BSI。根据受试者工作特征（ROC）曲线分析，该模型的截断值为0.722，灵敏度、特异度和曲线下面积（AUC）分别为90.5%、85.7%和0.921。
基于胃肠道损伤、替加环素暴露和定植菌株碳青霉烯耐药评分的风险预测模型可有效预测CRE定植患者发生CRE BSI的情况。对重点科室住院患者进行早期CRE筛查和检测可能有助于早期预警并降低CRE医院感染风险。
