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Association between MDROs colonization and subsequent infections in ICU patients: a retrospective cohort study
Shanbi Cheng1, Dejun Tong1, Qianqian Zhao2
1Department of Hospital Infection Control, The Second Xiangya Hospital Central South University, Changsha, Hunan, China.
Objective:
To investigate the association between multidrug-resistant organisms (MDROs) colonization and subsequent infection in intensive care unit (ICU) patients.
Methods:
A retrospective analysis was conducted on 388 ICU patients admitted to the Second Xiangya Hospital between January 2023 and December 2025. Patients were divided into infection (n = 47) and non-infection (n = 341) groups according to whether they developed an MDROs infection within 28 days of ICU admission. Clinical data were collected, and univariate and multivariate logistic regression analyses were performed to identify the factors associated with MDROs infection. A nomogram model was constructed.
Results:
Among the 388 ICU patients, 99 (25.52, 95%CI: 21.44-30.08%) were colonized by MDROs. A total of 108 MDROs isolates were detected, including 29 strains of ESBL-producing Escherichia coli (ESBL-EC, 26.61%), 54 strains of ESBL-producing Klebsiella pneumoniae (ESBL-KP, 49.54%), 16 strains of methicillin-resistant Staphylococcus aureus (MRSA, 14.68%), and 9 strains of methicillin-resistant Staphylococcus epidermidis (MRSE, 9.17%). Logistic regression analysis showed that diabetes (OR = 2.523, 95% CI: 1.095-5.814), MDROs colonization (OR = 5.155, 95% CI: 2.302-11.544), APACHE II score (OR = 2.043, 95% CI: 1.597-2.614), and albumin level (OR = 0.778, 95% CI: 0.679-0.893) were independent factors associated with MDROs infection in ICU patients. When these variables were incorporated into a logistic regression nomogram, the AUC values for the training and validation sets were 0.894 (95% CI: 0.832-0.957) and 0.896 (95% CI: 0.828-0.964), respectively.
Conclusion:
Diabetes, MDROs colonization, high APACHE II scores, and low albumin levels are factors associated with MDROs infection in ICU patients. The nomogram constructed based on these factors may facilitate the early identification of patients at high risk for MDROs infection and provide a basis for individualized treatment strategies.
Insights
Multidrug-resistant organism (MDRO) colonization significantly increases infection risk in intensive care unit (ICU) patients. Early identification of high-risk patients using factors like diabetes and APACHE II scores is crucial for effective treatment.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Intensive care units (ICUs) are high-risk environments for multidrug-resistant organism (MDRO) infections.
- Understanding the factors associated with MDRO colonization and subsequent infection is critical for patient management.
Purpose of the Study:
- To investigate the association between MDRO colonization and the development of MDRO infections in ICU patients.
- To identify independent risk factors for MDRO infections in the ICU setting.
- To develop a predictive model for early identification of high-risk patients.
Main Methods:
- Retrospective analysis of 388 ICU patients.
- Data collection including demographics, clinical factors, and MDRO status.
- Univariate and multivariate logistic regression analyses to identify risk factors.
- Construction and validation of a nomogram model.
Main Results:
- 25.52% of ICU patients were colonized with MDROs.
- Key risk factors for MDRO infection included diabetes, MDRO colonization, high APACHE II scores, and low albumin levels.
- The developed nomogram demonstrated high predictive accuracy (AUC 0.894-0.896).
Conclusions:
- Diabetes, MDRO colonization, high APACHE II scores, and low albumin levels are significant predictors of MDRO infection in ICU patients.
- The nomogram model offers a valuable tool for early risk stratification and personalized treatment strategies in ICUs.
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