预测第三代耐头孢菌素肠杆菌科引起的血流感染的Nomogram。

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance Pub Date : 2025-09-01 Epub Date: 2025-07-22 DOI:10.1016/j.jgar.2025.07.015

Chun-Lin Liu, Rui-Hang Huang, Zhi-Ying Deng, Qing-Nian Wu, Ping Chen, Zhi-Ting Huo, Jie Yao

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引用次数: 0

摘要

背景：肠杆菌科血流感染（bsi）的第三代头孢菌素耐药性（3GCR）对中国的临床管理提出了挑战。本研究旨在开发一种预测工具来指导抗生素的管理。方法：对某三级医院（2021-2023年）459例肠杆菌科bsi患者（185例3GCR， 274例第三代头孢菌素敏感[3GCS]）进行回顾性分析。多元逻辑回归与逆向选择确定的预测因素，整合成一个nomogram。结果：3GCR的独立预测因子包括高龄(优势比（OR)=1.02, 95%可信区间（CI）：1.01-1.04）、肝硬化（OR=2.18, 1.26-3.77）、实体肿瘤（OR=2.04, 1.19-3.50）、以前使用过第三代头孢菌素（OR=2.44, 1.47-4.08）和降钙素原升高（OR=1.01, 1.01-1.02）。nomogram显示中度判别（Area Under Curve, AUC =0.751, 95%CI:0.67-0.83）和良好的定标（Hosmer-Lemeshow P=0.757）。结论：该nomogram结合了现成的临床变量，促进了3GCR风险的快速分层。它的实施可以优化经验抗生素选择，改善结果，并减轻肠杆菌科bsi的耐药性升级。

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A nomogram to predict bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae.

Objectives: Third-generation cephalosporin resistance (3GCR) in Enterobacteriaceae bloodstream infections (BSIs) challenges clinical management in China. This study aimed to develop a predictive tool to guide antibiotic stewardship.

Methods: A retrospective cohort of 459 patients with Enterobacteriaceae BSIs (185 3GCR, 274 third-generation cephalosporin-sensitive [3GCS]) from a tertiary hospital (2021-2023) was analysed. Multivariate logistic regression with backward selection identified predictors, integrated into a nomogram.

Results: Independent 3GCR predictors included advanced age ( (Odds Ratio (OR) = 1.02, 95% Confidence Interval (CI): 1.01-1.04), liver cirrhosis (OR = 2.18, 1.26-3.77), solid tumours (OR = 2.04, 1.19-3.50), prior third-generation cephalosporin use (OR = 2.44 1.47-4.08), and elevated procalcitonin (OR = 1.01, 1.01-1.02). The nomogram showed moderate discrimination (Area Under Curve (AUC) = 0.751, 95% CI: 0.67-0.83) and good calibration (Hosmer-Lemeshow P = 0.757).

Conclusions: This nomogram, incorporating readily available clinical variables, facilitates rapid 3GCR risk stratification. Its implementation may optimize empirical antibiotic selection, improve outcomes, and mitigate resistance escalation in Enterobacteriaceae BSIs.

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来源期刊

Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

8.70

自引率

2.20%

发文量

285

审稿时长

34 weeks

期刊介绍： The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.