成年患有败血症患者抗菌素耐药性的风险模型的性能
M Cristina Vazquez Guillamet1,2, Hanyang Liu3, Andrew Atkinson1
1Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
JAMA network open
|November 7, 2024
概括
预测模型的败血症的风险分层的耐药性阴性菌 (GNB) 感染在各医院执行不一致. 局部耐药性流行,而不是患者因素,解释了这种变异性,需要谨慎使用通用模型.
科学领域:
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 医疗信息学 医疗信息学
背景情况:
- 预测模型的败血症的风险分层的耐药性阴性菌根 (GNB) 感染对于指导治疗至关重要.
- 现有的模型显示,在不同的医院环境中,外推结果很差.
研究的目的:
- 评估患者病例组合和局部耐药性流行是否影响GNB败血症风险分层模型的性能.
- 在多个机构中评估社区和医院发作的败血症的模型性能.
主要方法:
- 在10家医院 (2016-2021) 中,对39893名败血症患者进行了回顾性队列研究.
- 针对社区发病和医院发病的败血症开发的深度学习模型,按GNB耐药性分层 (易感性,抗 ceftriaxone,抗 ceftriaxone/cefepime).
- 使用AUROC和AUPRC评估的模型性能,与耐药性流行率和患者病例组合相关.
主要成果:
- 模型性能在各医院和患者子组之间有显著差异.
- 抗性GNB的当地流行率与模型性能有很强的相关性 (AUPRC:R=0.79,P=.001).
- 患者病例组合不是表现变化的主要驱动因素.
结论:
- 败血症预测模型的可变性能主要与局部抗菌素耐药性流行率有关,而不是患者病例组合.
- 在败血症中预测耐药GNB的通用模型需要谨慎应用,因为在医疗保健环境中性能可变性.
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