Başağa Sare Merve, Ulu Kılıç Ayşegül, Ture Zeynep, Zararsız Gökmen, Yerlitaş Serra İlayda
Department of Infectious Diseases, Eyüp Sultan State Hospital, İstanbul 34654, Türkiye.
Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri 38039, Türkiye.
Infect Dis Rep. 2025 Aug 1;17(4):92. doi: 10.3390/idr17040092.
BACKGROUND/OBJECTIVES: This study aimed to create a 'carbapenem resistance score' with the risk factors of carbapenem-resistant Gram-negative bacterial infections (GNBIs) in patients with hematological malignancies.
Patients with carbapenem-resistant and susceptible GNBIs were included in this study and compared in terms of risk factors. Three models of "carbapenem resistance risk scores" were created with statistically significant variables.
The study included 154 patients with hospital-acquired GNBIs, of whom 64 had carbapenem-resistant GNBIs and 90 had carbapenem-susceptible GNBIs. Univariate and multivariate analyses identified several statistically significant risk factors for carbapenem resistance, including transfer from another hospital or clinic ( = 0.038), prior use of antibiotics like fluoroquinolones ( = 0.009) and carbapenems ( = 0.001), a history of carbapenem-resistant infection in the last six months ( < 0.001), rectal colonization ( < 0.001), hospitalization for ≥30 days ( = 0.001), and the presence of a urinary catheter ( = 0.002). Notably, the 14-day mortality rate was significantly higher in the carbapenem-resistant group ( < 0.001). Based on these findings, three risk-scoring models were developed. Common factors in all three models were fluoroquinolone use in the last six months, rectal colonization, and the presence of a urinary catheter. The fourth variable was transfer from another hospital (Model 1), a history of carbapenem-resistant infection (Model 2), or hospitalization for ≥30 days (Model 3). All models demonstrated strong discriminative power (AUC for Model 1: 0.830, Model 2: 0.826, Model 3: 0.831). For all three models, a cutoff value of >2.5 was adopted as the threshold to identify patients at high risk for carbapenem resistance, a value which yielded high positive and negative predictive values.
This study successfully developed three practical risk-scoring models to predict carbapenem resistance in patients with hematological malignancies using common clinical risk factors. A cutoff score of >2.5 proved to be a reliable threshold for identifying high-risk patients across all models, providing clinicians with a valuable tool to guide appropriate empirical antibiotic therapy.
背景/目的：本研究旨在利用血液系统恶性肿瘤患者耐碳青霉烯类革兰阴性菌感染（GNBIs）的危险因素创建一个“耐碳青霉烯类评分”。
本研究纳入了耐碳青霉烯类和对碳青霉烯类敏感的GNBIs患者，并对其危险因素进行比较。利用具有统计学意义的变量创建了三种“耐碳青霉烯类风险评分”模型。
该研究纳入了154例医院获得性GNBIs患者，其中64例为耐碳青霉烯类GNBIs患者，90例为对碳青霉烯类敏感的GNBIs患者。单因素和多因素分析确定了几个耐碳青霉烯类的统计学显著危险因素，包括从另一家医院或诊所转入（P = 0.038）、先前使用过氟喹诺酮类（P = 0.009）和碳青霉烯类（P = 0.001）抗生素、过去六个月有耐碳青霉烯类感染史（P < 0.001）、直肠定植（P < 0.001）、住院≥30天（P = 0.001）以及存在导尿管（P = 0.002）。值得注意的是，耐碳青霉烯类组的14天死亡率显著更高（P < 0.001）。基于这些发现，开发了三种风险评分模型。所有三种模型的共同因素是过去六个月使用氟喹诺酮类、直肠定植和存在导尿管。第四个变量是从另一家医院转入（模型1）、耐碳青霉烯类感染史（模型2）或住院≥30天（模型3）。所有模型均显示出较强的判别能力（模型1的AUC为0.830，模型2为0.826，模型3为0.831）。对于所有三种模型，采用>2.5的截断值作为识别耐碳青霉烯类高风险患者的阈值，该值产生了较高的阳性和阴性预测值。
本研究成功开发了三种实用的风险评分模型，以利用常见临床危险因素预测血液系统恶性肿瘤患者的耐碳青霉烯类情况。>2.5的截断评分被证明是识别所有模型中高风险患者的可靠阈值，为临床医生提供了一个有价值的工具来指导适当的经验性抗生素治疗。
