[Pathogen Distribution,Imaging Characteristics,and Establishment and Verification of Risk Prediction Model of
Yong-Qiang Ye1, Lan-Lan He2, Gui-Ling Liu3
1Department of Radiology,South Taihu Hospital,Huzhou, Zhejiang 313000,China.
Abstract:
Objective To investigate the pathogen distribution,imaging characteristics,and risk factors of pulmonary infection with multi-drug resistant organism (MDRO) in patients with severe craniocerebral injury,and establish and verify the risk prediction model. Methods A total of 230 patients with severe craniocerebral injury complicated with pulmonary infection were collected retrospectively.According to the 7∶3 ratio,they were randomly assigned into a modeling group (161 patients) and a validation group (69 patients).The risk factors of MDRO pulmonary infection were predicted with the data of the modeling group for the establishment of the risk prediction model.The data of the validation group was used to validate the performance of the model. Results Among the 230 patients,68 patients developed MDRO pulmonary infection.The isolated drug-resistant bacteria mainly included multi-drug resistant Acinetobacter baumannii,multi-drug resistant Klebsiella pneumoniae,multi-drug resistant Pseudomonas aeruginosa,and methicillin-resistant Staphylococcus aureus,which accounted for 45.21%,23.29%,16.44%,and 15.07%,respectively.The imaging characteristics included pleural effusion,lung consolidation,and ground-glass shadow,which accounted for 72.06%,63.24%,and 45.59%,respectively.Multivariate Logistic regression analysis showed that the independent risk factors for MDRO pulmonary infection included age ≥60 years (P=0.003),history of diabetes (P=0.021),history of chronic obstructive pulmonary disease (P=0.038),mechanical ventilation ≥7 d (P=0.001),transfer from other hospitals (P=0.008),and coma (P=0.002).A risk scoring model was established with the β value (rounded to the nearest integer) corresponding to each index in the regression equation.Specifically,the β values of age ≥60 years,history of diabetes,history of chronic obstructive pulmonary disease,mechanical ventilation ≥7 d,transfer from other hospitals,and coma were 1,1,1,2,2,and 1,respectively (value ≥4 indicated a high-risk population).The areas under the receiver operating characteristic curve of the modeling group and validation group were 0.845 and 0.809,respectively. Conclusions Multi-drug resistant Acinetobacter baumannii is the most common pathogen of MDRO pulmonary infection in patients with severe craniocerebral injury.Pleural effusion,lung consolidation,and ground-glass shadow were the most common imaging characteristics.The established risk model has high discriminant validity in both the modeling group and the validation group.
Insights
Multi-drug resistant organism pulmonary infections are common in severe craniocerebral injury patients. A new risk model identifies key factors like age, diabetes, and ventilation duration for early detection.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Radiology
Background:
- Pulmonary infection with multi-drug resistant organisms (MDRO) poses a significant threat to patients with severe craniocerebral injury.
- Understanding the specific pathogens, imaging findings, and risk factors is crucial for effective management.
- Developing a predictive model can aid in early identification and intervention for high-risk individuals.
Purpose of the Study:
- To determine the distribution of pathogens causing pulmonary infections in severe craniocerebral injury patients.
- To identify characteristic imaging findings associated with MDRO pulmonary infections.
- To establish and validate a risk prediction model for MDRO pulmonary infection in this patient population.
Main Methods:
- Retrospective analysis of 230 patients with severe craniocerebral injury and pulmonary infection.
- Patients were divided into modeling (161) and validation (69) groups.
- Multivariate logistic regression was used to identify risk factors and build a predictive model.
Main Results:
- 68 patients developed MDRO pulmonary infections, with multi-drug resistant *Acinetobacter baumannii* being the most prevalent pathogen.
- Common imaging findings included pleural effusion (72.06%), lung consolidation (63.24%), and ground-glass shadow (45.59%).
- Independent risk factors identified were age ≥60, diabetes, COPD, prolonged mechanical ventilation, hospital transfer, and coma.
Conclusions:
- Multi-drug resistant *Acinetobacter baumannii* is the primary pathogen in MDRO pulmonary infections post-severe craniocerebral injury.
- Pleural effusion, lung consolidation, and ground-glass shadows are key imaging indicators.
- The developed risk scoring model demonstrates high validity in predicting MDRO pulmonary infection risk.
