Sebastián Marciano, Salvatore Piano, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Dong Joon Kim, Sung Eun Kim, Elza Soares, Mónica Marino, Julio Vorobioff, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Singh, Martín Elizondo, Maria M Anders, Melisa Dirchwolf, Manuel Mendizabal, Cosmas R A Lesmana, Claudio Toledo, Florence Wong, Francois Durand, Adrián Gadano, Diego H Giunta, Paolo Angeli
{"title":"肝硬化患者耐多药细菌感染预测模型的开发和外部验证。","authors":"Sebastián Marciano, Salvatore Piano, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Dong Joon Kim, Sung Eun Kim, Elza Soares, Mónica Marino, Julio Vorobioff, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Singh, Martín Elizondo, Maria M Anders, Melisa Dirchwolf, Manuel Mendizabal, Cosmas R A Lesmana, Claudio Toledo, Florence Wong, Francois Durand, Adrián Gadano, Diego H Giunta, Paolo Angeli","doi":"10.1111/liv.16063","DOIUrl":null,"url":null,"abstract":"<p><p>With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis.</p><p><strong>Methods: </strong>We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility.</p><p><strong>Results: </strong>The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%).</p><p><strong>Conclusion: </strong>This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":null,"pages":null},"PeriodicalIF":6.0000,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Development and external validation of a model to predict multidrug-resistant bacterial infections in patients with cirrhosis.\",\"authors\":\"Sebastián Marciano, Salvatore Piano, Virendra Singh, Paolo Caraceni, Rakhi Maiwall, Carlo Alessandria, Javier Fernandez, Dong Joon Kim, Sung Eun Kim, Elza Soares, Mónica Marino, Julio Vorobioff, Manuela Merli, Laure Elkrief, Victor Vargas, Aleksander Krag, Shivaram Singh, Martín Elizondo, Maria M Anders, Melisa Dirchwolf, Manuel Mendizabal, Cosmas R A Lesmana, Claudio Toledo, Florence Wong, Francois Durand, Adrián Gadano, Diego H Giunta, Paolo Angeli\",\"doi\":\"10.1111/liv.16063\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. 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引用次数: 0
摘要
随着耐多药生物(MDRO)感染率的上升,选择适当的经验性抗生素已成为一项挑战。我们的目的是开发并从外部验证一个预测肝硬化患者MDRO感染风险的模型:我们纳入了两项前瞻性研究中的肝硬化和细菌感染患者:一项跨洲研究用于模型开发和内部验证(n = 1302),一项来自阿根廷和乌拉圭的研究用于外部验证(n = 472)。所有预测因子均在感染时进行测量。培养阳性和培养阴性感染均包括在内。模型的建立采用了逻辑回归法,并对预测因子进行了后向逐步选择。我们使用校准和判别统计对乐观调整模型进行了外部验证,并评估了其临床实用性:结果:在开发数据集和外部验证数据集中,MDRO 感染率分别为 19% 和 22%。该模型的预测因子包括性别、既往抗生素使用情况、感染类型和部位、MELD-Na、血管加压剂使用情况、急性-慢性肝衰竭以及交互项。经外部验证,校准斜率为 77(95% CI .48-1.05),ROC 曲线下面积为 .68(95% CI .61-.73)。该模型的应用极大地改变了检测后感染 MDRO 的概率,识别出了低风险(8%)的院内感染患者和高风险(36%)的社区获得性感染患者:该模型性能良好,可用于改善经验性抗生素的选择,并与其他抗生素管理计划策略相一致。
Development and external validation of a model to predict multidrug-resistant bacterial infections in patients with cirrhosis.
With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis.
Methods: We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility.
Results: The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%).
Conclusion: This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.
期刊介绍:
Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.