Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 May 19;9(1):66.
doi: 10.1186/s13756-020-00726-5.

Predicting the occurrence of multidrug-resistant organism colonization or infection in ICU patients: development and validation of a novel multivariate prediction model

Li Wang  1 , Xiaolong Huang  2 , Jiating Zhou  2 , Yajing Wang  1 , Weizhang Zhong  1 , Qing Yu  1 , Weiping Wang  1 , Zhiqiao Ye  1 , Qiaoyan Lin  1 , Xing Hong  1 , Ping Zeng  1 , Minwei Zhang  3
Affiliations
Observational Study

Predicting the occurrence of multidrug-resistant organism colonization or infection in ICU patients: development and validation of a novel multivariate prediction model

Li Wang et al. Antimicrob Resist Infect Control. .

Abstract

Background: Multidrug-resistant organisms (MDROs) have emerged as an important cause of poor prognoses of patients in the intensive care unit (ICU). This study aimed to establish an easy-to-use nomogram for predicting the occurrence of MDRO colonization or infection in ICU patients.

Methods: In this study, we developed a nomogram based on predictors in patients admitted to the ICU in the First Affiliated Hospital of Xiamen University from 2016 to 2018 using univariate and multivariate logistic regression analysis. We externally validated this nomogram in patients from another hospital over a similar period, and assessed its performance by calculating the area under the receiver operating characteristic (ROC) curve (AUC) and performing a decision curve analysis.

Results: 331 patients in the primary cohort and 181 patients in the validation cohort were included in the statistical analysis. Independent factors derived from the primary cohort to predict MDRO colonization or infection were male sex, higher C-reactive protein (CRP) levels and higher Pitt bacteremia scores (Pitt scores), which were all assembled in the nomogram. The nomogram yielded good discrimination with an AUC of 0.77 (95% CI 0.70-0.84), and the range of threshold probabilities of decision curves was approximately 30-95%.

Conclusion: This easy-to-use nomogram is potentially useful for predicting the occurrence of MDRO colonization or infection in ICU patients.

Keywords: CRP; Colonization; ICU; Infection; Multidrug-resistant organisms; Pitt score.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for screening eligible patients
Fig. 2
Fig. 2
a The nomogram to predict the occurrence of MDRO colonization or infection in ICU patients. This nomogram provides a method of calculating the probability of the occurrence of MDRO colonization or infection in the ICU based on a patient’s combination of covariates in the early stages of the ICU stay. To use the nomogram, locate the patient’s gender, and draw a line straight up to the points axis to establish the score associated with that gender. Repeat for the other two covariates. Add the scores for each covariate together, and locate the total score on the total points axis. Draw a line straight down to the linear predictor axis to obtain the probability. b. An example of how to use the nomogram to predict the occurrence of MDRO colonization or infection in ICU patients. A male patient has a CRP value of 50 mg/L within 48 h of entering the ICU, and his Pitt score is 6 points. The points for each predictor add up to 66.5. A vertical line is then drawn from 66.5 on the “Total points” line down to the last lines to predict further MDRO colonization or infection (63.7%)
Fig. 3
Fig. 3
a. The receiver operating characteristic curves for the nomogram in the external validation cohort. The AUC for our model was 0.77 (95% CI 0.70–0.84). b. Decision curves for the overall incidence of MDRO colonization or infection according to the nomogram in the external validation cohort. Gray line: net benefit of a strategy of predicting all patients; black line: net benefit of predicting no patients; dotted line: net benefit of predicting patients according to the nomogram. The nomogram-based decisions were supported in the range of threshold probabilities of approximately 30–95%
See this image and copyright information in PMC

References

    1. Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no eskape. Infect Dis. 2008;197(8):1079–1081. - PubMed
    1. Albiger B, Glasner C, Struelens MJ, Grundmann H, Monnet DL. Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries. Euro Surveill. 2015;20(45):1–18. - PubMed
    1. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard deinitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–281. - PubMed
    1. Organization W H Antimicrobial resistance: global report on surveillance. Australasian Med J. 2014;7(4):237.
    1. Ministry of Health PRC Technical guidelines for the prevention and control of nosocomial infection with multidrug resistant bacteria (trial) Chin Crit Care Med. 2011;13(2):108–109.

Publication types

Substances