Construction and validation of risk prediction models for carbapenem-resistant <i>Klebsiella pneumoniae</i> infections_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

TENG Shuangqin , KUANG Jing , SHEN Tongtong , YAN Yiran ,  WANG Wei

Department of Infectious Diseases, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P. R. China;

Corresponding author：

WANG Wei, Email: wangwei_1211@126.com

Keywords：

Klebsiella pneumoniae; carbapenem resistance; risk factors; prediction model

DOI：

10.7507/1671-6205.202403029

Video：

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Objective To investigate the risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, and construct a clinical model for predicting the risk of CRKP infections. Methods A retrospective analysis was performed on Klebsiella pneumoniae infection patients hospitalized in the Third Hospital of Hebei Medical University from May 2020 to May 2021. The patients were divided into a CRKP group (117 cases) and a Carbapenem-sensitive Klebsiella pneumoniae (CSKP) group (191 cases). The predictors were screened by full subset regression using R software (version 4.3.1). The truncation values of continuous data were determined by Youden index. Nomogram and score table model for CRKP infections risk prediction was constructed based on binary logistic regression. The receiver operator characteristic (ROC) curve and area under curve (AUC) were used to evaluate the accuracy of models. Calibration curve and decision curve were used to evaluate the performance of models. Results 308 patients with Klebsiella pneumoniae infections were included. A total of 8 predictors were selected by using full subset regression and truncation values were determined according to Youden index: intensive care unit (ICU) stay at time of infection>2 days, male, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score>15 points, hospitalization stay at time of infection>10 days, any history of Gram-negative bacteria infection in the last 6 months, heart disease, lung infection, antibiotic exposure history in the last 6 months. The AUC of CRKP prediction risk curve model was 0.811 (95%CI 0.761 - 0.860). When the optimal cut-off value of the constructed CRKP prediction risk rating table was 6 points, the AUC was 0.723 (95%CI 0.672 - 0.774). The Bootstrap method was used for internal repeated sampling for 1000 times for verification. The model calibration curve and Hosmer-Lemeshow test (P=0.618) showed that these models have good calibration degree. The decision curve showed that these models have good clinical effectiveness. Conclusion The prediction model of CRKP infections based on the above 8 risk factors can be used as a risk prediction tool for clinical identification of CRKP infections.

Citation： TENG Shuangqin, KUANG Jing, SHEN Tongtong, YAN Yiran, WANG Wei. Construction and validation of risk prediction models for carbapenem-resistant Klebsiella pneumoniae infections. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(11): 761-768. doi: 10.7507/1671-6205.202403029 Copy

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12.	Yang D, Xie Z, Xin X, et al. A model for predicting nosocomial carbapenem-resistant Klebsiella pneumoniae infection. Biomed Rep, 2016, 5(4): 501-505.
13.	Pilote L, Dasgupta K, Guru V, et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ, 2007, 176(6): S1-S44.
14.	Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J, 2008, 29(1): 96-103.
15.	Nguyen J L, Yang W, Ito K, et al. Seasonal influenza infections and cardiovascular disease mortality. JAMA Cardiol, 2016, 1(3): 274-281.
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18.	Chen Y, Ying S, Jiang L, et al. A novel nomogram for predicting risk factors and outcomes in bloodstream infections caused by Klebsiella pneumoniae. Infect Drug Resist, 2022, 15: 1317-1328.
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21.	Lee Y R, Baker NT. Meropenem-vaborbactam: a carbapenem and beta-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae. Eur J Clin Microbiol Infect Dis, 2018, 37(8): 1411-1419.
22.	Li Y, Shen H, Zhu C, et al. Carbapenem-resistant Klebsiella pneumoniae Infections among ICU admission patients in Central China: prevalence and prediction model. Biomed Res Int, 2019, 2019: 9767313.
23.	Zhang P, Wang J, Hu H, et al. Clinical characteristics and risk factors for bloodstream infection due to carbapenem-resistant Klebsiella pneumoniae in patients with hematologic malignancies. Infect Drug Resist, 2020, 13: 3233-3242.
24.	Giannella M, Trecarichi EM, De Rosa FG, et al. Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study. Clin Microbiol Infect, 2014, 20(12): 1357-1362.

1. World Health Organization. New report calls for urgent action to avert antimicrobial resistance crisis. (2019-04-29)[2023-04-01]. https://www.who.int/news-room/detail/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis.
2. 胡付品, 郭燕, 朱德妹, 等. 2021年CHINET中国细菌耐药监测. 中国感染与化疗杂志, 2022, 22(5): 521-530.
3. Logan LK, Weinstein RA. The epidemiology of carbapenem-resistant enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis, 2017, 215(suppl_1): S28-S36.
4. Li Y, Li J, Hu T, et al. Five-year change of prevalence and risk factors for infection and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary hospital in North China. Antimicrob Resist Infect Control, 2020, 9(1): 79.
5. Zhen X, Stalsby Lundborg C, Sun X, et al. Clinical and economic burden of carbapenem-resistant infection or colonization caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii: a multicenter study in China. Antibiotics (Basel), 2020, 9(8): 514.
6. Xu L, Sun X, Ma X. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob, 2017, 16(1): 18.
7. Clinical and Laboratory Standards Institute. M100-S25. performance standards for antimicrobial susceptibility testing; twenty-ffifth informational supplements. Wayne PA: CLSI, 2015.
8. Daikos GL, Tsaousi S, Tzouvelekis LS, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother, 2014, 58(4): 2322-2328.
9. Gutierrez-Gutierrez B, Salamanca E, De Cueto M, et al. Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study. Lancet Infect Dis, 2017, 17(7): 726-734.
10. Shields RK, Nguyen MH, Chen L, et al. Ceftazidime-avibactam is superior to other treatment regimens against carbapenem-resistant Klebsiella pneumoniae bacteremia. Antimicrob Agents Chemother, 2017, 61(8): e00883-17.
11. Folgori L, Bielicki J. Future challenges in pediatric and neonatal sepsis: emerging pathogens and antimicrobial resistance. J Pediatr Intensive Care, 2019, 8(1): 17-24.
12. Yang D, Xie Z, Xin X, et al. A model for predicting nosocomial carbapenem-resistant Klebsiella pneumoniae infection. Biomed Rep, 2016, 5(4): 501-505.
13. Pilote L, Dasgupta K, Guru V, et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ, 2007, 176(6): S1-S44.
14. Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J, 2008, 29(1): 96-103.
15. Nguyen J L, Yang W, Ito K, et al. Seasonal influenza infections and cardiovascular disease mortality. JAMA Cardiol, 2016, 1(3): 274-281.
16. Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol, 2018, 8: 4.
17. 王欣, 沈丹丹, 刘银梅, 等. 重症监护病房患者检出耐碳青霉烯类肺炎克雷伯菌的危险因素分析. 中国呼吸与危重监护杂志, 2022, 21(3): 158-161.
18. Chen Y, Ying S, Jiang L, et al. A novel nomogram for predicting risk factors and outcomes in bloodstream infections caused by Klebsiella pneumoniae. Infect Drug Resist, 2022, 15: 1317-1328.
19. Van Loon K, Voor in 'T Holt AF, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother, 2017, 62(1): e01730-17.
20. Fortini A, Faraone A, Di Pietro M, et al. Antimicrobial stewardship in an Internal Medicine ward: effects on antibiotic consumption and on the use of carbapenems. Intern Emerg Med, 2018, 13(8): 1219-1226.
21. Lee Y R, Baker NT. Meropenem-vaborbactam: a carbapenem and beta-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae. Eur J Clin Microbiol Infect Dis, 2018, 37(8): 1411-1419.
22. Li Y, Shen H, Zhu C, et al. Carbapenem-resistant Klebsiella pneumoniae Infections among ICU admission patients in Central China: prevalence and prediction model. Biomed Res Int, 2019, 2019: 9767313.
23. Zhang P, Wang J, Hu H, et al. Clinical characteristics and risk factors for bloodstream infection due to carbapenem-resistant Klebsiella pneumoniae in patients with hematologic malignancies. Infect Drug Resist, 2020, 13: 3233-3242.
24. Giannella M, Trecarichi EM, De Rosa FG, et al. Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study. Clin Microbiol Infect, 2014, 20(12): 1357-1362.

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