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. 2024 Nov 3:17:4833-4841.
doi: 10.2147/IDR.S479374. eCollection 2024.

Risk Factors for Multidrug Resistance in Patients Infected with Carbapenem-Resistant Klebsiella pneumoniae: A Nomogram

Yaning Gao  1 , Liang Chen  1 , Zhengjun Wen  1 , Huiying Jiang  1 , Jing Feng  1
Affiliations

Risk Factors for Multidrug Resistance in Patients Infected with Carbapenem-Resistant Klebsiella pneumoniae: A Nomogram

Yaning Gao et al. Infect Drug Resist. .

Abstract

Purpose: Our aim was to determine the risk factors for multidrug resistance in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP).

Methods: The information of 196 patients with Klebsiella pneumoniae infection was collected. The patients were subsequently assigned to the carbapenem-resistant, multidrug-resistant, and non-multidrug-resistant groups. The risk factors for multidrug resistance in CRKP patients were assessed via least absolute shrinkage and selection operator and logistic regression analyses. Moreover, a nomogram was constructed dependent on the identified risk factors, and calibration and decision curves were plotted to detect its accuracy.

Results: Length of stay (LOS) [odds ratio (OR) and 95% confidence interval (CI): 4.558 (1.157-17.961), P = 0.030], intensive care unit (ICU) stay within 30 days [OR and 95% CI: 12.643 (3.780-42.293), P < 0.001], Glasgow Coma Scale (GCS) score [OR and 95% CI: 13.569 (2.738-67.236), P = 0.001], fungal infection [OR and 95% CI: 6.398 (1.969-20.785), P = 0.002], and cardiovascular disease (CVD) [OR and 95% CI: 3.871 (1.293-11.592), P = 0.016] were identified as risk factors for multidrug resistance in CRKP patients. The concordance index (C-index) of the constructed nomogram was 0.950 (95% CI: 0.945-0.955). Moreover, decision curve analysis elucidated the nomogram utilization across a wide range of probability thresholds, ranging from 1% to 100%. Finally, internal validation using random data validated the robustness of the predictive model, yielding a C-index of 0.937.

Conclusion: The LOS, ICU stay within 30 days, GCS score, fungal infection, and CVD were recognized as risk factors for multidrug resistance in CRKP patients. The constructed nomogram could accurately predict multidrug-resistant CRKP infections in patients.

Keywords: Klebsiella pneumoniae; carbapenem; multidrug resistance; prediction model; risk factors.

Plain language summary

The LOS, ICU stay within 30 days, GCS, fungal infection, and CVD were identified as risk factors for multidrug resistance in CRKP patients.The nomogram constructed in this study had high predictive accuracy.This study provides a reference for the formulation of personalized prevention and therapy strategies.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Least absolute selection and shrinkage operator (LASSO) regression analysis. (A) Tuning parameter (λ) selection in the LASSO model was conducted using 10-fold cross-validation via minimum criteria. (B) LASSO coefficient profiles of the 18 features.
Figure 2
Figure 2
Nomogram. (A) Nomogram construction. (B) Calibration curve. (C) Decision curve.
See this image and copyright information in PMC

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