Wang Jundi, Su Kaisheng, Wang Shuying, Yang Yanfei
Department of Rheumatology and Immunology, Hangzhou First People's Hospital Affiliated of Westlake University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Department of Hospital Infection Management, Hangzhou First People's Hospital Affiliated of Westlake University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Infect Drug Resist. 2025 Aug 20;18:4189-4199. doi: 10.2147/IDR.S532928. eCollection 2025.
Invariably, patients can be exposed to Carbapenem-resistant Enterobacteriaceae (CRE) through contaminated device during Endoscopic retrograde cholangiopancreatography (ERCP). We aimed to identify the risk factors and establish a model for predicting subsequent CRE infections in patients with CRE-positive bile screening after ERCP.
Patients underwent ERCP were performed with bile active screening of CRE. Medical records were reviewed to identify patient demographics, comorbidities, microbiology and antimicrobial treatments. The results were grouped according to the occurrence of subsequent CRE infection, and the patients were divided into two groups: a CRE infection group and a non-CRE infection group. The diagnosis for CRE infection was confirmed by more than 2 physicians. Logistic regression methods were used to determine the risk factors for CRE infections. The risk prediction model was constructed by integrating the clinical data and the result of logistic regression, by a nomogram and forest plot. Finally, goodness of fit of the final model was tested using the likelihood ratio test.
Central venous catheterization (OR=11.32; 95% CI 1.15-40.62), cholecystitis (OR=3.82; 95% CI 1.12-13.01), malignancy (OR=4.33; 95% CI 1.41-13.35) and the antimicrobial drug use (OR=1.08; 95% CI 1.03-1.14) were considered as highly relevant risk factors for subsequent CRE infections in bile active screening positive patients. The goodness of fit test indicated that the model was well-calibrated for both groups.
A targeted active screening in bile samples can be beneficial for patients with high risk factors of CRE infections. The nomogram developed in this study can help clinicians accurately predict the possibility of patients with subsequent CRE infections after ERCP, so as to facilitate more precise individualized treatment.
在内镜逆行胰胆管造影术（ERCP）期间，患者不可避免地会通过受污染的器械接触到耐碳青霉烯类肠杆菌科细菌（CRE）。我们旨在确定风险因素，并建立一个模型来预测ERCP术后胆汁筛查CRE阳性患者随后发生CRE感染的情况。
对接受ERCP的患者进行胆汁中CRE的主动筛查。查阅病历以确定患者的人口统计学特征、合并症、微生物学和抗菌治疗情况。根据随后是否发生CRE感染对结果进行分组，将患者分为两组：CRE感染组和非CRE感染组。CRE感染的诊断由两名以上医生确认。采用逻辑回归方法确定CRE感染的风险因素。通过整合临床数据和逻辑回归结果，绘制列线图和森林图构建风险预测模型。最后，使用似然比检验对最终模型的拟合优度进行检验。
中心静脉置管（OR=11.32；95%CI 1.15-40.62）、胆囊炎（OR=3.82；95%CI 1.12-13.01）、恶性肿瘤（OR=4.33；95%CI 1.41-13.35）和抗菌药物使用（OR=1.08；95%CI 1.03-1.14）被认为是胆汁主动筛查阳性患者随后发生CRE感染的高度相关风险因素。拟合优度检验表明该模型在两组中校准良好。
对胆汁样本进行有针对性的主动筛查对有CRE感染高风险因素的患者可能有益。本研究开发的列线图可帮助临床医生准确预测ERCP术后患者随后发生CRE感染的可能性，从而便于更精确的个体化治疗。
