Development and application of a risk nomogram for the prediction of risk of carbapenem-resistant Acinetobacter baumannii infections in neuro-intensive care unit: a mixed method study.
Carbapenem-resistant Acinetobacter
baumannii infections
Mixed method study
Neuro-ICU patients
Prediction model
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
13 Jun 2024
13 Jun 2024
Historique:
received:
19
12
2023
accepted:
04
06
2024
medline:
13
6
2024
pubmed:
13
6
2024
entrez:
12
6
2024
Statut:
epublish
Résumé
This study aimed to develop and apply a nomogram with good accuracy to predict the risk of CRAB infections in neuro-critically ill patients. In addition, the difficulties and expectations of application such a tool in clinical practice was investigated. A mixed methods sequential explanatory study design was utilized. We first conducted a retrospective study to identify the risk factors for the development of CRAB infections in neuro-critically ill patients; and further develop and validate a nomogram predictive model. Then, based on the developed predictive tool, medical staff in the neuro-ICU were received an in-depth interview to investigate their opinions and barriers in using the prediction tool during clinical practice. The model development and validation is carried out by R. The transcripts of the interviews were analyzed by Maxqda. In our cohort, the occurrence of CRAB infections was 8.63% (47/544). Multivariate regression analysis showed that the length of neuro-ICU stay, male, diabetes, low red blood cell (RBC) count, high levels of procalcitonin (PCT), and number of antibiotics ≥ 2 were independent risk factors for CRAB infections in neuro-ICU patients. Our nomogram model demonstrated a good calibration and discrimination in both training and validation sets, with AUC values of 0.816 and 0.875. Additionally, the model demonstrated good clinical utility. The significant barriers identified in the interview include "skepticism about the accuracy of the model", "delay in early prediction by the indicator of length of neuro-ICU stay", and "lack of a proper protocol for clinical application". We established and validated a nomogram incorporating six easily accessed indicators during clinical practice (the length of neuro-ICU stay, male, diabetes, RBC, PCT level, and the number of antibiotics used) to predict the risk of CRAB infections in neuro-ICU patients. Medical staff are generally interested in using the tool to predict the risk of CRAB, however delivering clinical prediction tools in routine clinical practice remains challenging.
Identifiants
pubmed: 38867312
doi: 10.1186/s13756-024-01420-6
pii: 10.1186/s13756-024-01420-6
doi:
Substances chimiques
Carbapenems
0
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
62Subventions
Organisme : National Natural Science Foundation of China
ID : No. 82172603
Organisme : Natural Science Foundation of Jiangsu Province
ID : BK20221280
Organisme : Analysis and Knowledge Services of Yangzhou University
ID : YBK202202
Organisme : Chinese Postdoctoral Science Foundation
ID : 2022M711426
Organisme : Jiangsu Province Health Commission New Technology Introduction and Evaluation Project
ID : M2022044
Organisme : Special Fund for Social Key Research and Development Plan of Yangzhou City
ID : YZ2022097
Informations de copyright
© 2024. The Author(s).
Références
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