Infection and Drug Resistance (Jan 2024)

Risk Factors and Predictive Nomogram for Carbapenem-Resistant Klebsiella pneumoniae in Children in a Grade 3 First-Class General Hospital in Central China

  • Chu X,
  • Ning L,
  • Fang Y,
  • Jia H,
  • Wang M

Journal volume & issue
Vol. Volume 17
pp. 41 – 49

Abstract

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Xinmin Chu,1 Lijuan Ning,2,3,* Yuting Fang,2,3,* Hengmin Jia,4 Meng Wang2,3 1Department of Clinical Laboratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China; 2Department of Pharmacy, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China; 3Anhui Provincial Key Laboratory of Precision Pharmaceutical Preparations and Clinical Pharmacy, Hefei, Anhui, 230001, People’s Republic of China; 4Department of Infection Office, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China*These authors contributed equally to this workCorrespondence: Meng Wang, Department of Pharmacy, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China, Email [email protected]: This study determined risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP)in children admitted to a grade 3 first-class general hospital and developed an individualized line graph predictive model.Methods: The clinical data of 185 children infected with Klebsiella pneumoniae from January 2015 to December 2019 were analyzed retrospectively. Patients were grouped according to carbapenem resistance: CRKP group (50 cases) and CSKP (carbapenem-sensitive Klebsiella pneumoniae) group (135 cases). Risk factors for CRKP in children were screened by logistic regression analysis. The predictive model was established using R software and validated using the Bootstrap method.Results: Age (odds ratio [OR]=0.104, 95% confidence interval [CI]: 0.026– 0.408), intensive care unit admission (OR =2.829, 95% CI: 1.138– 7.030), mechanical ventilation (OR =7.510, 95% CI: 3.140– 17.961), surgery history (OR =5.005, 95% CI: 1.507– 16.618) and glucocorticoid (OR =0.235, 95% CI: 0.099– 0.557) were independent risk factors for CRKP in children (P < 0.05), The total risk score of each factor was 362.5, and the risk rate was 0.1– 0.9. In receiver-operating characteristic curve analysis, the area under the curve of CRKP predicted by the total risk score was 0.872 (95% CI=0.844– 0.901; P < 0.001). The correction curve indicated that the consistency between the observed value and the predicted value was good.Discussion and Conclusion: This study successfully established a model based on the risk factors, with high accuracy and good predictive value for CRKP in children. Hospitals should take necessary preventive measures against the risk factors for drug-resistant bacteria, such as optimizing the configuration of ICU space, timely isolation of infected children, and adequate disinfection of ICU equipment. Which may reduce CRKP infection rate.Keywords: Klebsiella pneumoniae, carbapenem resistance, risk factors, nomogram, children

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