Development and Validation of a Nomogram to Predict Multidrug-Resistant Organism Infection in Severe Pneumonia: A
1Department of Intensive Care Medicine, Ganzhou People's Hospital, Ganzhou, 341000, People's Republic of China.
Objective:
The purpose of this study was to explore the etiological characteristics of multidrug-resistant bacteria (MDRO) infection in patients with severe pneumonia (SP) and to construct a nomogram model based on their risk factors.
Methods:
A total of 214 severe pneumonia (SP) patients admitted from November 2022 to January 2024 were retrospectively assigned to the modeling group, and 92 patients admitted from February 2024 to March 2025 formed the validation group. Patients were categorized into MDRO and non-MDRO groups based on multidrug-resistant organism infection status. The distribution of pathogens in the MDRO group was analyzed. Logistic regression was performed to analyze the influencing factors. R software was performed to construct nomogram models. Decision curve analysis(DCA) was performed to evaluate the clinical application value of nomogram models.
Results:
A total of 93 strains of pathogenic bacteria were isolated from 72 MDRO-infected patients. Gram-negative bacteria showed the highest resistance to piperacillin-tazobactam and piperacillin, while Gram-positive bacteria exhibited a high resistance rate to penicillin.Logistic analysis showed types of pneumonia, chronic obstructive pulmonary disease(COPD), invasive examination,intensive care unit(ICU) admission, antimicrobial drug combination, use of carbapenems, and hypoalbuminemia were risk factors (P<0.05). The modeling group achieved an area under curve(AUC) of 0.910, with the Hosmer-Lemeshow (H-L) test showing χ2 = 7.423. DCA indicated that the nomogram model had high clinical utility for predicted probabilities between 0.07 and 0.94. In the validation group, the AUC was 0.953, with H-L test χ2 = 7.032. DCA showed that the nomogram model had high clinical value for predicted probabilities between 0.07 and 0.89.
Conclusion:
The types of pneumonia, COPD, invasive examination, ICU admission, combination of antimicrobial drugs, carbapenems use, and hypoalbuminemia are influencing factors for MDRO infection in SP patients. The nomogram constructed based on this can better evaluate the risk of MDRO infection.
Insights
This study identified key risk factors for multidrug-resistant bacteria (MDRO) infections in severe pneumonia (SP) patients. A developed nomogram model effectively predicts MDRO risk, aiding clinical decision-making.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Microbiology
Background:
- Severe pneumonia (SP) poses significant challenges, often complicated by multidrug-resistant bacteria (MDRO).
- Understanding the risk factors for MDRO infections in SP is crucial for effective patient management and infection control.
Purpose of the Study:
- To investigate the etiological characteristics of MDRO infections in patients with severe pneumonia.
- To develop and validate a nomogram model for predicting the risk of MDRO infection in SP patients.
Main Methods:
- Retrospective analysis of 214 SP patients for model development and 92 for validation.
- Categorization into MDRO and non-MDRO groups based on infection status.
- Logistic regression for risk factor identification and nomogram construction using R software, with Decision Curve Analysis (DCA) for clinical utility assessment.
Main Results:
- Gram-negative bacteria showed high resistance to piperacillin-tazobactam and piperacillin; Gram-positive bacteria to penicillin.
- Identified risk factors for MDRO infection include pneumonia type, COPD, invasive examination, ICU admission, antimicrobial drug combinations, carbapenem use, and hypoalbuminemia (P<0.05).
- The nomogram demonstrated high predictive accuracy in both modeling (AUC=0.910) and validation (AUC=0.953) groups, with significant clinical utility.
Conclusions:
- Pneumonia type, COPD, invasive examination, ICU admission, antimicrobial drug combinations, carbapenem use, and hypoalbuminemia are significant influencing factors for MDRO infection in SP patients.
- The developed nomogram model provides a valuable tool for assessing the risk of MDRO infection in severe pneumonia patients, supporting clinical practice.
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