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Carbapenem resistant gram negative bacteremia in intensive care unit patients: Development and validation of a
Nesrin Turker1, Ozge Eren Korkmaz2, Figen Kaptan Aydogmus1
1Izmir Katip Celebi Universty Ataturk Training and Research Hospital, Department of Infection Diseaeses and Clinical Microbiology, Izmir, Turkey.
Background:
Carbapenem-resistant Gram-negative bloodstream infections (CR-GNB BSIs) are increasingly prevalent in intensive care units (ICUs) and associated with high mortality. Accurate early risk stratification tools are lacking.
Objectives:
To develop and internally validate a nomogram-based model predicting 30-day mortality in ICU patients with CR-GNB BSIs.
Methods:
We conducted a retrospective cohort study of adult ICU patients with CR-GNB BSIs at a tertiary hospital in western Turkey (January 2020-October 2024). Demographic, clinical, laboratory, and microbiological data were collected. Patients were randomly split into training (70 %) and validation (30 %) cohorts. Univariable and multivariable logistic regression analyses identified independent mortality predictors, which were incorporated into a nomogram. Model discrimination, calibration, and decision-curve utility were evaluated.
Results:
A total of 281 patients were included (median age 66 years; 60.9 % male); 30-day mortality was 58 %. Acinetobacter spp. predominated (51.6 %), followed by Klebsiella spp. (42.3 %) and Pseudomonas spp. (6.1 %). Independent predictors of 30-day mortality included older age, immunosuppression, hypoalbuminemia, elevated white blood cell count, and absence of microbiological cure. The nomogram demonstrated excellent discrimination (AUC 0.895 training; 0.854 validation), good calibration (mean absolute error 0.022-0.059), and meaningful clinical net benefit across intermediate risk thresholds.
Conclusions:
We developed and internally validated a nomogram using routine clinical and laboratory variables to predict 30-day mortality in ICU patients with CR-GNB BSIs. This tool may support early prognostic assessment at bedside and guide individualized management. Prospective multicenter validation is warranted.
