摘要
目的开发并验证用于预测碳青霉烯类耐药肺炎克雷伯菌(CRKP)患者血流感染(BSI)风险的模型。方法检索PubMed、Corchrane图书馆和Embase数据库从建库至2022年7月发表的与CRKP-BSI危险因素相关的文献并进行筛选,提取纳入研究中具有统计学意义的CRKP-BSI危险因素的相对危险度(RR)进行合并,根据所有危险因素的权重建立CRKP-BSI风险预测模型。通过外部验证队列评估模型性能,纳入2016年1月至2022年1月在上海市第一人民医院住院期间确诊CRKP感染患者作为验证队列,对每例患者的临床数据进行风险预测并计算风险评分;绘制受试者工作特征曲线(ROC曲线)衡量预测的准确性;根据最佳截断值将CRKP感染患者分为中低风险组和高风险组,比较两组间CRKP-BSI发生率。结果共有16篇文献组成衍生队列,其中6篇为回顾性队列研究,10篇为病例对照研究。共纳入6475例诊断为CRKP感染的患者,其中1306例患者发生CRKP-BSI,发生率为20.2%。CRKP-BSI风险预测模型的危险因素包括心血管疾病、严重的中性粒细胞减少症或免疫抑制状态、重症监护病房(ICU)住院史、既往住院史、碳青霉烯类抗菌药物暴露、氨基糖苷类抗菌药物暴露、抗真菌药物暴露、气管插管或气管切开术、机械通气、血液透析、中心静脉置管、留置导尿管、CRKP定植、其他非感染部位KP阳性。所有危险因素均按其权重评分,最高分173.5分。验证队列共纳入230例CRKP感染患者,其中41例CRKP感染患者进展为CRKP-BSI。外部验证显示,该模型预测CRKP-BSI发生风险的曲线下面积(AUC)=0.783〔95%置信区间(95%CI)为0.689~0.876〕,最佳截断值为81.25分,敏感度为75.6%,特异度为81.0%。根据最佳截断值将230例CRKP感染患者分为中低风险组(163例)和高风险组(67例)。与中低风险组相比,高风险组患者CRKP-BSI发生率明显更高〔64.2%(43/67)比4.9%(8/163);RR=13.175(95%CI为5.920~29.319),P<0.001〕。结论该模型利用14个常用临床参数来预测CRKP-BSI的发生风险,具有良好的预测能力,可辅助临床医生早期识别高危患者。
Objective To develop and validate a predictive model for the risk of bloodstream infection(BSI)caused by carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods A literature search was conducted in PubMed,Cochrane Library,and Embase databases from inception to July 2022 to identify studies reporting statistically significant risk factors for CRKP-BSI.Relative risks(RR)were extracted and pooled.Based on factor weights,a risk-scoring model was established.For external validation,hospitalized CRKP-infected patients from January 2016 to January 2022 at Shanghai First People's Hospital were included.Clinical data were used to calculate individual risk scores.The predictive accuracy was assessed using receiver operator characteristic curve(ROC curve).Patients were stratified into low-to-intermediate-risk and high-risk groups based on the optimal cut-off,and CRKP-BSI incidence was compared between groups.Results The literatures related to the risk factors of CRKP-BSI published from database inception to July 2022 was retrieved and screened from PubMed,Cochrane Library,and Embase.Fourteen risk factors were included in the scoring model:cardiovascular disease,severe neutropenia or immunosuppression,intensive care unit(ICU)stay history,prior hospitalization,carbapenem exposure,aminoglycoside exposure,antifungal exposure,endotracheal intubation or tracheostomy,mechanical ventilation,hemodialysis,central venous catheter,indwelling urinary catheter,CRKP colonization,and Klebsiella pneumoniae positivity at non-infection sites.The total score ranged from 0 to 173.5 points.In the validation cohort of 230 CRKP-infected patients,41 developed CRKP-BSI.The model yielded an area under the curve(AUC)of 0.783(95%CI was 0.689-0.876).The optimal cut-off was 81.25 points,with sensitivity of 75.6%and specificity of 81.0%.Based on this cut-off,163 patients were categorized as low-to-intermediate risk and 67 patients as high risk.The incidence of CRKP-BSI in the high-risk group was significantly higher than in the low-to-intermediate-risk group[64.2%(43/67)vs.4.9%(8/163);RR=13.175(95%CI was 5.920-29.319),P<0.001].ConclusionThe model,based on 14 routinely available clinical parameters,demonstrated good performance in predicting CRKP-BSI risk and may assist clinicians in early identification of high-risk patients.
作者
金珊珊
周芳庆
魏东坡
郑晶晶
陈常兴
王瑞兰
Jin Shanshan;Zhou Fangqing;Wei Dongpo;Zheng Jingjing;Chen Changxing;Wang Ruilan(Department of Critical Care Medicine,Shanghai General Hospital of Nanjing Medical University(Shanghai General Hospital,Shanghai Jiaotong University,School of Medicine),Shanghai 200080,China)
出处
《中华危重病急救医学》
北大核心
2025年第9期822-828,共7页
Chinese Critical Care Medicine
基金
国家自然科学基金(82472218)
国家临床重点专科建设项目(Z155080000004)
四大慢病重大专项(2023ZD0506502)
上海市卫生健康系统重点扶持学科建设项目(2023ZDFC0102)。
关键词
细菌耐药性
碳青霉烯类耐药肺炎克雷伯菌
血流感染
预测模型
META分析
Antimicrobial resistance
Carbapenem-resistant Klebsiella pneumoniae
Bloodstream infection
Predictive model
Meta-analysis
