Department of Clinical Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine (Jinhua Municipal Central Hospital), Jinhua, Zhejiang, China.
Department of Clinical Laboratory, Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang, China.
Front Cell Infect Microbiol. 2024 Sep 30;14:1475428. doi: 10.3389/fcimb.2024.1475428. eCollection 2024.
Extensively drug-resistant Acinetobacter baumannii (XDRAB) has become a significant pathogen in hospital environments, particularly in intensive care units (ICUs). XDRAB's resistance to conventional antimicrobial treatments and ability to survive on various surfaces pose a substantial threat to patient health, often resulting in severe infections such as ventilator-associated pneumonia (VAP) and bloodstream infections (BSI).
We retrospectively analyzed clinical data from 559 patients with XDRAB infections admitted to Jinhua Central Hospital between January 2021 and December 2023. Patients were randomly divided into a training set (391 cases) and a testing set (168 cases). Variables were selected using Lasso regression and logistic regression analysis, and a predictive model was constructed and validated internally and externally. Model performance and clinical utility were evaluated using the Hosmer-Lemeshow test, C-index, ROC curve, decision curve analysis (DCA), and clinical impact curve (CIC).
Lasso regression analysis was used to screen 35 variables, selecting features through 10-fold cross-validation. We chose lambda.1se=0.03450 (log(lambda.1se)=-3.367), including 10 non-zero coefficient features. These features were then included in a multivariate logistic regression analysis, identifying 8 independent risk factors for XDRAB infection: ICU stay of 1-7 days (OR=3.970, 95%CI=1.586-9.937), ICU stay >7 days (OR=12.316, 95%CI=5.661-26.793), hypoproteinemia (OR=3.249, 95%CI=1.679-6.291), glucocorticoid use (OR=2.371, 95%CI=1.231-4.564), urinary catheterization (OR=2.148, 95%CI=1.120-4.120), mechanical ventilation (OR=2.737, 95%CI=1.367-5.482), diabetes mellitus (OR=2.435, 95%CI=1.050-5.646), carbapenem use (OR=6.649, 95%CI=2.321-19.048), and β-lactamase inhibitor use (OR=4.146, 95%CI=2.145-8.014). These 8 factors were used to construct a predictive model visualized through a nomogram. The model validation showed a C-index of 0.932 for the training set and 0.929 for the testing set, with a Hosmer-Lemeshow test p-value of 0.47, indicating good calibration. Furthermore, the DCA curve demonstrated good clinical decision-making performance, and the CIC curve confirmed the model's reliable clinical impact.
Regression analysis identified ICU stay duration, hypoproteinemia, glucocorticoid use, urinary catheterization, mechanical ventilation, diabetes mellitus, carbapenem use, and β-lactamase inhibitor use as independent risk factors for XDRAB infection. The corresponding predictive model demonstrated high accuracy and stability.
广泛耐药的鲍曼不动杆菌（XDRAB）已成为医院环境中的重要病原体，特别是在重症监护病房（ICU）中。XDRAB 对常规抗菌治疗的耐药性以及在各种表面存活的能力对患者健康构成了重大威胁，经常导致严重感染，如呼吸机相关性肺炎（VAP）和血流感染（BSI）。
我们回顾性分析了 2021 年 1 月至 2023 年 12 月期间在金华市中心医院住院的 559 例 XDRAB 感染患者的临床数据。患者被随机分为训练集（391 例）和测试集（168 例）。使用 Lasso 回归和逻辑回归分析选择变量，并构建和内部和外部验证预测模型。使用 Hosmer-Lemeshow 检验、C 指数、ROC 曲线、决策曲线分析（DCA）和临床影响曲线（CIC）评估模型性能和临床实用性。
Lasso 回归分析用于筛选 35 个变量，通过 10 倍交叉验证选择特征。我们选择了 lambda.1se=0.03450（log(lambda.1se)=-3.367），包括 10 个非零系数特征。然后，这些特征被纳入多变量逻辑回归分析，确定了 XDRAB 感染的 8 个独立危险因素：入住 ICU 1-7 天（OR=3.970，95%CI=1.586-9.937）、入住 ICU >7 天（OR=12.316，95%CI=5.661-26.793）、低蛋白血症（OR=3.249，95%CI=1.679-6.291）、糖皮质激素使用（OR=2.371，95%CI=1.231-4.564）、导尿（OR=2.148，95%CI=1.120-4.120）、机械通气（OR=2.737，95%CI=1.367-5.482）、糖尿病（OR=2.435，95%CI=1.050-5.646）、碳青霉烯类药物使用（OR=6.649，95%CI=2.321-19.048）和β-内酰胺酶抑制剂使用（OR=4.146，95%CI=2.145-8.014）。这些 8 个因素用于构建通过列线图可视化的预测模型。模型验证显示，训练集的 C 指数为 0.932，测试集的 C 指数为 0.929，Hosmer-Lemeshow 检验 p 值为 0.47，表明良好的校准。此外，DCA 曲线显示了良好的临床决策性能，CIC 曲线证实了模型的可靠临床影响。
回归分析确定了 ICU 入住时间、低蛋白血症、糖皮质激素使用、导尿、机械通气、糖尿病、碳青霉烯类药物使用和β-内酰胺酶抑制剂使用是 XDRAB 感染的独立危险因素。相应的预测模型具有较高的准确性和稳定性。
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