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Risk Prediction of Multidrug-Resistant Infections in Pediatric Burn Patients with Hospital-Acquired Infections: A
Zhongsen Sun1, Peilong Li1, Chunjie Fan1
1From the Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University.
Background:
Multidrug-resistant organism (MDRO) infections pose a growing threat to pediatric burn patients, contributing to prolonged hospitalization, increased health care burden, and limited therapeutic options. Despite their clinical significance, predictive tools specific to MDRO infections in this population remain scarce. The authors aimed to identify independent clinical predictors of MDRO infection among pediatric burn patients with health care-associated infections (HAIs) and to construct a validated nomogram for individualized risk estimation.
Methods:
A retrospective cohort study was conducted at a tertiary-care pediatric burn center in China, including patients 1 month to 18 years of age who developed HAIs between January of 2020 and December of 2023. Multivariable logistic regression was used to identify independent risk factors, and a nomogram was constructed accordingly. Model performance was evaluated using the area under the receiver operating characteristic curve, calibration plot, decision curve analysis, and clinical impact curve.
Results:
Among 763 pediatric burn patients with HAIs, 93 (12.2%) developed MDRO infections. Six independent predictors were identified: total burn surface area, hospital length of stay, intensive care unit admission, mechanical ventilation, central venous catheter use, and acute inhalation injury. The nomogram demonstrated excellent discrimination (area under the receiver operating characteristic curve 0.962), good calibration, and favorable clinical utility across a range of threshold probabilities.
Conclusions:
This study presents a clinically applicable nomogram for early prediction of MDRO infection in pediatric burn patients with HAIs. The tool may support individualized risk stratification, guide targeted preventive interventions, and inform empirical antibiotic decision-making in burn care settings. Prospective validation is warranted.
Insights
Multidrug-resistant organism (MDRO) infections are a serious risk for pediatric burn patients. A new nomogram identifies key predictors like burn size and ICU stay to help predict MDRO infections early.
Area of Science:
- Pediatric critical care
- Infectious disease epidemiology
- Burn injury management
Background:
- Multidrug-resistant organism (MDRO) infections present a significant challenge in pediatric burn care, leading to extended hospital stays and limited treatment options.
- Predictive tools for MDRO infections in pediatric burn patients are currently lacking, necessitating further research.
Purpose of the Study:
- To identify independent clinical predictors of multidrug-resistant organism (MDRO) infection in pediatric burn patients with healthcare-associated infections (HAIs).
- To develop and validate a nomogram for individualized risk estimation of MDRO infections in this vulnerable population.
Main Methods:
- A retrospective cohort study involving 763 pediatric burn patients with HAIs at a Chinese tertiary-care center (January 2020-December 2023).
- Multivariable logistic regression analysis was employed to determine independent risk factors.
- Nomogram construction and validation using ROC curve, calibration plots, and decision curve analysis.
Main Results:
- Out of 763 patients, 93 (12.2%) acquired MDRO infections.
- Six independent predictors were identified: total burn surface area, length of hospital stay, ICU admission, mechanical ventilation, central venous catheter use, and acute inhalation injury.
- The developed nomogram showed excellent predictive performance (AUC = 0.962) with good calibration and clinical utility.
Conclusions:
- A validated nomogram is presented for the early prediction of MDRO infections in pediatric burn patients with HAIs.
- This tool can aid in risk stratification, targeted prevention, and empirical antibiotic strategies in burn care.
- Further prospective validation of the nomogram is recommended.
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