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. 2024 Jun 13;13(1):62.
doi: 10.1186/s13756-024-01420-6.

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

Yuping Li #  1   2 , Xianru Gao #  1   3 , Haiqing Diao #  1   3 , Tian Shi  3 , Jingyue Zhang  1   3 , Yuting Liu  3 , Qingping Zeng  1   3 , JiaLi Ding  1   3 , Juan Chen  1   3 , Kai Yang  4 , Qiang Ma  1 , Xiaoguang Liu  1 , Hailong Yu  1   5 , Guangyu Lu  6   7   8
Affiliations

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

Yuping Li et al. Antimicrob Resist Infect Control. .

Erratum in

Abstract

Objective: 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.

Methods: 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.

Results: 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".

Conclusions: 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.

Keywords: Carbapenem-resistant Acinetobacter baumannii infections; Mixed method study; Neuro-ICU patients; Prediction model.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
A Nomogram to predict the risk of CRKP infection in neuro-ICU patients. B Example of an application of the nomogram to predict the occurrence of CRKP infection in neuro-ICU patients
Fig. 3
Fig. 3
A The ROC curves of the nomogram model in the training set. B The ROC curves of the nomogram model in the validation set
Fig. 4
Fig. 4
The calibration curve of the nomogram model in the validation set
Fig. 5
Fig. 5
Decision curve analysis of the nomogram model
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