Predicting carbapenem-resistant Enterobacteriaceae infections in pediatric liver transplant recipients
Yang-Yang Wang1, Wei-Li Wang1, Yan Sun2,3
1Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, China.
Insights
Carbapenem-resistant Enterobacteriaceae (CRE) infections are a risk after pediatric liver transplants. This study identified key risk factors and developed nomograms to predict CRE infections, aiding protective measures.
Area of Science:
- Hepatology
- Transplantation Immunology
- Infectious Diseases
Background:
- Pediatric liver transplant recipients face significant risks from Carbapenem-resistant Enterobacteriaceae (CRE) infections.
- Identifying risk factors and developing predictive tools for CRE infections is crucial in this vulnerable population.
Purpose of the Study:
- To identify independent risk factors for CRE infections post-pediatric liver transplantation.
- To develop and validate prediction models (nomograms) for CRE infection in pediatric liver transplant recipients.
Main Methods:
- Logistic regression analysis was used to identify risk factors in pediatric liver transplant patients (2017-2023).
- Prediction models were built and validated using training, internal, and external cohorts.
- Performance was evaluated using receiver operating characteristic curves and area under the curve (AUC).
Main Results:
- CRE intestinal colonization pre-transplant, bile/intestinal leakage, and respiratory RNA virus infections were significant risk factors.
- A model with all three factors achieved AUCs of 0.724 (training) and 0.738 (internal validation).
- A two-factor model (colonization, leakage) showed strong performance with AUCs of 0.738 (internal) and 0.828 (external validation).
Conclusions:
- Developed nomograms accurately predict CRE infection risk in pediatric liver transplant recipients.
- These tools can guide the implementation of targeted preventive strategies.
- Early identification of high-risk patients can improve outcomes after pediatric liver transplantation.
Background:
Carbapenem-resistant Enterobacteriaceae (CRE) infections can pose a significant risk following pediatric liver transplantations. This study aimed to identify risk factors for CRE infections and develop prediction models for pediatric recipients.
Methods:
This study enrolled pediatric patients who underwent liver transplantation between 2017 and 2023. Risk factors for CRE infection were identified using logistic regression analysis. Prediction models were constructed using a training cohort and validated using internal and external validation cohorts. Predictive performance was assessed using receiver operating characteristic curves and area under the curve (AUC).
Results:
CRE intestinal colonization before liver transplantation, bile or intestinal leakage and respiratory ribonucleic acid virus infections were independent risk factors for CRE infection after pediatric liver transplantation. Our prediction model comprising all three factors achieved AUC values of 0.724 and 0.738 in the training and internal validation cohorts, respectively. The AUC of an additional model constructed using CRE intestinal colonization and bile or intestinal leakage achieved 0.738 and 0.828 in the internal and external validation cohorts, respectively. Two nomograms were constructed.
Conclusions:
Both nomograms accurately predicted CRE infection after liver transplantation. They can facilitate the adoption of essential protective measures in pediatric liver transplant recipients.
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