Infection and Drug Resistance (Mar 2022)

Derivation and Validation of a Predictive Scoring Model of Infections Due to Acinetobacter baumannii in Patients with Hospital Acquired Pneumonia by Gram-Negative Bacilli

  • Sun K,
  • Li W,
  • Li Y,
  • Li G,
  • Pan L,
  • Jin F

Journal volume & issue
Vol. Volume 15
pp. 1055 – 1066

Abstract

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Kang Sun,1,2 Wangping Li,1 Yu Li,3,4 Guangyu Li,5 Lei Pan,1 Faguang Jin1 1Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The 989th Hospital of Joint Support Force of Chinese People’s Liberation Army, Luoyang, Henan Province, 471003, People’s Republic of China; 3Department of Infectious Diseases, Shaanxi Provincial People’s Hospital and The Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi Province, 710068, People’s Republic of China; 4Shaanxi Center for Models of Clinical Medicine in International Cooperation of Science and Technology, Xi’an, Shaanxi Province, 710068, People’s Republic of China; 5Department of Pathology, University of Texas Medical Branch, Galveston, TX, 77555, USACorrespondence: Lei Pan; Wangping Li, Department of Respiratory and Critical Care Medicine, Tang Du Hospital, Air Force Military Medical University, Xi’an, Shaanxi Province, 710038, People’s Republic of China, Email [email protected]; [email protected]: The prognosis of ABA-HAP patients is very poor. This study aimed to develop a scoring model to predict ABA-HAP in patients with GNB-HAP.Methods: A single center retrospective cohort study was performed among patients with HAP caused by GNB in our hospital during January 2019 to June 2019 (the derivation cohort, DC). The variables were assessed on the day when qualified respiratory specimens were obtained. A prediction score was formulated by using independent risk factors obtained from logistic regression analysis. It was prospectively validated with a subsequent cohort of GNB-HAP patients admitted to our hospital during July 2019 to Dec 2019 (the validation cohort, VC).Results: The final logistic regression model of DC included the following variables: transferred from other hospitals (3 points); blood purification (3 points); risk for aspiration (4 points); immunocompromised (3 points); pulmonary interstitial fibrosis (3 points); pleural effusion (1 points); heart failure (3 points); encephalitis (5 points); increased monocyte count (2 points); and increased neutrophils count (2 points). The AUROC of the scoring model was 0.845 (95% CI, 0.796 ∼ 0.895) in DC and 0.807 (95% CI, 0.759 ∼ 0.856) in VC. The scoring model clearly differentiated the low-risk patients (the score < 8 points), moderate-risk patients (8 ≤ the score < 12 points) and high-risk patients (the score ≥ 12 points), both in DC (P < 0.001) and in VC (P < 0.001).Conclusion: This simple scoring model could predict ABA-HAP with high predictive value and help clinicians to choose appropriate empirical antibiotic therapy.Keywords: Acinetobacter baumannii, hospital acquired pneumonia, Gram-negative bacilli, predictive scoring model, empirical antibiotic therapy

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