Su Min Seo1, Ihn Sook Jeong2, Ju Yeon Song3, Sangjin Lee4. 1. Infection Control Unit, Dongeui Medical Center, Busan, Republic of Korea. Electronic address: tnals5833@naver.com. 2. College of Nursing, Pusan National University, Yangsan, Republic of Korea. Electronic address: jeongis8342@gmail.com. 3. Infection Control Team, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. Electronic address: lierlier1092@hanmail.net. 4. Graduate School, Department of Statistics, Pusan National University, 2, Busandaehak-ro 63 beon-gil, Geumjeong-gu, 46241, Busan, South Korea. Electronic address: bir1031@hanmail.net.
Abstract
PURPOSE: This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. METHODS: This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018 and September 31, 2019 in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. RESULTS: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation (APACHE) II score at the time of admission, use of a central venous catheter and a nasogastric tube, and use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, and sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. CONCLUSION: The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.
PURPOSE: This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. METHODS: This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018 and September 31, 2019 in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. RESULTS: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation (APACHE) II score at the time of admission, use of a central venous catheter and a nasogastric tube, and use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, and sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. CONCLUSION: The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.