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临床流行病学与烧伤患者中心静脉相关血流感染的新型预测列线图

Clinical epidemiology and a novel predicting nomogram of central line associated bloodstream infection in burn patients.

机构信息

Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), ChongqingChina.

Laboratory of Trauma Care, School of Nursing, Third Military Medical University (Army Medical University), ChongqingChina.

出版信息

Epidemiol Infect. 2023 May 23;151:e90. doi: 10.1017/S0950268823000766.

Abstract

Burn patients are at high risk of central line-associated bloodstream infection (CLABSI). However, the diagnosis of such infections is complex, resource-intensive, and often delayed. This study aimed to investigate the epidemiology of CLABSI and develop a prediction model for the infection in burn patients. The study analysed the infection profiles, clinical epidemiology, and central venous catheter (CVC) management of patients in a large burn centre in China from January 2018 to December 2021. In total, 222 burn patients with a cumulative 630 CVCs and 5,431 line-days were included. The CLABSI rate was 23.02 CVCs per 1000 line-days. The three most common bacterial species were , and ; 76.09% of isolates were multidrug resistant. Compared with a non-CLABSI cohort, CLABSI patients were significantly older, with more severe burns, more CVC insertion times, and longer total line-days, as well as higher mortality. Regression analysis found longer line-days, more catheterisation times, and higher burn wounds index to be independent risk factors for CLABSI. A novel nomogram based on three risk factors was constructed with an area under the receiver operating characteristic curve (AUROC) value of 0.84 (95% CI: 0.782-0.898) with a mean absolute error of calibration curve of 0.023. The nomogram showed excellent predictive ability and clinical applicability, and provided a simple, practical, and quantitative strategy to predict CLABSI in burn patients.

摘要

烧伤患者存在发生中心静脉导管相关血流感染(CLABSI)的高风险。然而,此类感染的诊断较为复杂,需要耗费大量资源,且往往会出现延迟。本研究旨在调查 CLABSI 的流行病学情况,并为烧伤患者的感染开发一种预测模型。该研究分析了中国一家大型烧伤中心 2018 年 1 月至 2021 年 12 月期间患者的感染情况、临床流行病学和中心静脉导管(CVC)管理。共有 222 例烧伤患者,累计使用 630 根 CVC,累计导管留置天数为 5431 天。CLABSI 发生率为每 1000 个导管留置天数 23.02 例。三种最常见的细菌分别是 、 和 ;76.09%的分离株为多重耐药菌。与非 CLABSI 队列相比,CLABSI 患者年龄明显更大,烧伤更严重,CVC 插入次数更多,总导管留置天数更长,死亡率也更高。回归分析发现,导管留置天数更长、置管次数更多、烧伤创面指数更高是 CLABSI 的独立危险因素。基于这三个危险因素构建了一个新的列线图,其受试者工作特征曲线(ROC)下面积(AUC)值为 0.84(95%CI:0.782-0.898),校准曲线平均绝对误差为 0.023。该列线图显示出了良好的预测能力和临床适用性,为预测烧伤患者的 CLABSI 提供了一种简单、实用且定量的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79a7/10265734/9765382b9aa6/S0950268823000766_fig1.jpg

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