Construction of a predictive model for nosocomial infection of ESBLs-producing Klebsiella pneumoniae in ICU
OBJECTIVE To explore the predictive model for nosocomial infection of extended-spectrum-β-lactamase-producing(ESBLs-producing)Klebsiella pneumoniae in intensive care unit(ICU).METHODS A total of 157 pa-tients who developed nosocomial infection of Klebsiella pneumoniae in the ICU of Jining NO.1 People's Hospital from Jan.2019 to Dec.2022 were selected,of which 71 patients with ESBLs-KP hospital acquired infection were in the infection group and the remaining 86 cases were in the non-infection group.The source of specimens and drugs resistance were analyzed,and multivariate logistic regression analysis was used to analyze the factors of nos-ocomial infection with ESBLs-producing Klebsiella pneumoniae,and a risk predictive model of nomogram was constructed.Hosmer-Lemeshow was used to assess the risk model fit,and the model was evaluated and validated using the area under the curve of the receiver operating characteristic(ROC)curve and calibration curves.RESULTS Specimens from 157 patients with KP hospital infections were predominantly respiratory tract speci-mens,accounting for 39.49％and ESBLs-producing Klebsiella pneumoniae nosocomial infections were predomi-nantly urinary tract infections(33 cases,46.48％).The ESBLs producing strains of nosocomial infection were more sensitive to carbapenems and amikacin antibiotics,and the resistance rate of ESBLs-producing strains to most antimicrobial drugs was generally higher than that of ESBLs non-producing strains(P＜0.05).Multivariate logistic regression analysis indicated that days of ICU stay,history of use of cephalosporin and quinolone,and hy-poproteinemia were independent risk factors for nosocomial infection of ESBLs-producing Klebsiella pneumoniae in ICU(P＜0.05).Based on which,the nomogram risk prediction model was constructed,and th Hosmer-Leme-show test showed that the fitting degree of the risk prediction model was good(P=0.226),with an AUC of 0.785(95％CI:0.712-0.857),a sensitivity of 83.70％,a specificity of 63.40％,and the calibration curves showed that the risk prediction model was well differentiated and well calibrated.CONCLUSION The drug resist-ance of ESBLs-producing Klebsiella pneumoniae was still very high,and the nomogram risk prediction model constructed on the basis of the risk factors of ESBLs-producing Klebsiella pneumoniae nosocomial infection had good discrimination and calibration.
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