脑梗死患者发生MRSA感染危险因素分析及预测模型构建

doi:10.3760/cma.j.issn.1007-1245.2024.17.014

国际医药卫生导报 ›› 2024, Vol. 30 ›› Issue (17): 2888-2894.DOI: 10.3760/cma.j.issn.1007-1245.2024.17.014

脑梗死患者发生MRSA感染危险因素分析及预测模型构建

梅闯闯^1,2 蔡栋昊^1,2 李晓君^2,3

¹广东省第二中医院检验科，广州　510095；²广东省中医药研究开发重点实验室，广州　510095；³广东省第二中医院院感管理科，广州　510095

收稿日期:2024-05-11 出版日期:2024-09-01 发布日期:2024-09-23
通讯作者: 蔡栋昊，Email：583795382@qq.com
基金资助:
广东省中医药局课题（20232008）

Risk factors for MRSA infection in patients with cerebral infarction and establishment of a clinical prediction model

Mei Chuangchuang^1,2, Cai Donghao^1,2, Li Xiaojun^2,3

¹Department of Clinical Laboratory, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou 510095, China; ²Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou 510095, China; ³Department of Hospital Infection Control, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou 510095, China

Received:2024-05-11 Online:2024-09-01 Published:2024-09-23
Contact: Cai Donghao, Email: 583795382@qq.com
Supported by:
Project of Guangdong Bureau of Traditional Chinese Medicine (20232008)

摘要/Abstract

摘要：

目的　明确广东省第二中医院脑梗死患者耐甲氧西林金黄色葡萄球菌（MRSA）感染的危险因素，并建立临床预测模型，为MRSA的感染防治提供参考。方法　选取2021年1月至2023年12月于广东省第二中医院住院并诊断为金黄色葡萄球菌感染的脑梗死患者277例进行回顾性研究，其中男188例，女89例，年龄77（29，100）岁。根据是否耐甲氧西林分为MRSA组和甲氧西林敏感金黄色葡萄球菌（MSSA）组。采用χ²检验、秩和检验比较两组间差异。使用R 4.3.0语言对数据进行统计和可视化处理，采用最优子集回归分析和多因素logistic回归分析脑梗死患者合并MRSA感染的危险因素，建立相应列线图模型。绘制受试者操作特征曲线（ROC）和DCA曲线对模型进行评价。结果　广东省第二中医院MRSA分离率为71.84%（199/277）。多因素logistic回归分析结果显示，肌酐降低（OR=0.995，95%CI 0.992～0.999）、使用中心静脉插管（OR=2.390，95%CI 1.262～4.223）、感染前呼吸科住院史（OR=4.683，95%CI 1.377～15.929）、联用抗菌药物（OR=2.270，95%CI 1.231～4.187）是脑梗死患者发生MRSA感染的独立危险因素。基于最优子集回归分析得到的6个变量建立的列线图模型的曲线下面积为0.720，灵敏度、特异度、准确度分别为67.84%、70.51%、68.59%，诊断及预测性能尚可。结论　临床上应关注脑梗死患者MRSA感染危险因素，并利用本列线图模型预测感染发生。

关键词:

脑梗死, MRSA, 危险因素, 列线图

Abstract:

Objective　To identify the risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in patients with cerebral infarction in Guangdong Provincial Second Hospital of Traditional Chinese Medicine and establish a clinical prediction model, which can provide references for the prevention and treatment of MRSA infection. Methods　A total of 277 patients diagnosed with cerebral infarction and Staphylococcus aureus infection who were hospitalized in Guangdong Provincial Second Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were included in this retrospective analysis, including 188 males and 89 females who were 77 (29, 100) years old. According to whether they were methicillin-resistant, the patients were divided into a MRSA group and a methicillin-susceptible Staphylococcus aureus (MSSA) group. The data were compared between the two groups by χ² and rank sum tests. R 4.3.0 was used for the data statistics and visualization processing; the optimal subset regression analysis and multivariate logistic regression analysis were used to analyze the risk factors of the cerebral infarction patients complicated by MRSA infection; a corresponding nomogram model was established. The receiver operating characteristic curve (ROC) and DCA curve were drawn to evaluate the model. Results　The isolation rate of MRSA in Guangdong Provincial Second Hospital of Traditional Chinese Medicine was 71.84% (199/277). The multivariate logistic regression analysis showed that creatinine reduction (OR=0.995, 95%CI 0.992-0.999), using central venous catheterization (OR=2.390, 95%CI 1.262-4.223), history of hospitalization in respiratory department before infection (OR=4.683, 95%CI 1.377-15.929), and combined use of antibiotics (OR=2.270, 95%CI 1.231-4.187) were independent risk factors for MRSA infection in the patients. The area under the curve of the nomogram model based on the 6 variables obtained from the optimal subset regression analysis was 0.720; the sensitivity, specificity, and accuracy were 67.84%, 70.51%, and 68.59%, respectively. The diagnostic and predictive performance was acceptable. Conclusion　We should pay attention to the risk factors of MRSA infection in patients with cerebral infarction, and use the nomogram model to predict the occurrence of MRSA infection.

Key words:

Cerebral infarction, MRSA, Risk factors, Nomogram

梅闯闯蔡栋昊李晓君.

脑梗死患者发生MRSA感染危险因素分析及预测模型构建 [J]. 国际医药卫生导报, 2024, 30(17): 2888-2894.

Mei Chuangchuang, Cai Donghao, Li Xiaojun.

Risk factors for MRSA infection in patients with cerebral infarction and establishment of a clinical prediction model [J]. International Medicine and Health Guidance News, 2024, 30(17): 2888-2894.

参考文献

[1] Huang Y, Li Y, Pan H, et al. Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide[J]. J Glob Health, 2023, 13: 4160. DOI: 10.7189/jogh.13.04160.
[2] 刘云红,孙明洁,张佑健,等. 急性脑梗死感染对抗氧化能力与血小板参数的影响[J]. 中国实用神经疾病杂志,2019,22(2):144-148. DOI: 10.12083/SYSJ.2019.02.028.
[3] Urra X, Laredo C, Zhao Y, et al. Neuroanatomical correlates of stroke-associated infection and stroke-induced immunodepression[J]. Brain Behav Immun, 2017, 60: 142-150. DOI: 10.1016/j.bbi.2016.10.004.
[4] 霍叶红,张淑霞,王世超. 某院392例脑梗死患者并发医院感染的病原学特点与危险因素分析[J]. 抗感染药学, 2022, 19(7): 1050-1054. DOI: 10.13493/j.issn.1672-7878. 2022.07-035.
[5] 乔家林.急性脑梗死患者医院感染病原菌及耐药性探析[J]. 实用中西医结合临床, 2022, 22(17): 79-82. DOI: 10.13638/j.issn.1671-4040.2022.17.023.
[6] WHO bacterial priority pathogens list, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. https://www.who.int/publications/i/item/9789240093461.
[7] Siddiqui A H, Koirala J. Methicillin-Resistant Staphylococcus aureus[J]. 2024.
[8] 全国细菌耐药监测网. 2018—2021年中医医院多重耐药菌监测报告[J]. 中国感染控制杂志,2023,22(10):1148-1158. DOI: 10.12138/j.issn.1671-9638.20233800.
[9] 张杰,谢星星,范小冬,等. 耐甲氧西林金黄色葡萄球菌血流感染危险因素的系统评价[J]. 药物评价研究,2023,46(10):2243-2250. DOI: 10.7501/j.issn.1674-6376.2023.10.023.
[10] 谢栋,禹洁,李正翔. MRSA血流感染患者万古霉素相关肾毒性预测模型构建[J]. 国际医药卫生导报,2024,30(6):978-983. DOI: 10.3760/cma.j.issn.1007-1245. 2024.06.020.
[11] 王琪红, 吴婷婷. 个体化预测儿童反复呼吸道感染发生的列线图模型建立[J]. 中国妇幼保健,2024,39(12):2206-2209. DOI: 10.19829/j.zgfybj.issn.1001-4411. 2024.12.018
[12] Wang C, Che Y. A ultrasonic nomogram of quantitative parameters for diagnosing breast cancer [J]. Sci Rep, 2023, 13(1): 12340. DOI: 10.1038/s41598-023-39686-2.
[13] Rodriguez-Garcia J, Gamino-Iriarte A, Rodea-Montero ER. Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital[J]. PLoS One, 2015, 10(3): e118980. DOI: 10.1371/journal.pone.0118980.
[14] Wright AK, Newby C, Hartley RA, et al. Myeloid-derived suppressor cell-like fibrocytes are increased and associated with preserved lung function in chronic obstructive pulmonary disease[J]. Allergy, 2017, 72(4): 645-655. DOI: 10.1111/all.13061.
[15] 李骄星, 王玉芳, 孙逊沙, 等. 脑梗死合并医院感染的临床特点与危险因素分析[J]. 中国神经精神疾病杂志,2019,45(5):257-261. DOI:10.3969/j.issn.1002-0152. 2019.05.001.
[16] 顾申申, 李杰, 张键, 等. 基于全球医院感染暴发数据库和CNKI数据库的ICU医院感染暴发案例分析[J]. 中国感染控制杂志, 2021, 20(11): 1035-1040. DOI: 10.12138/j.issn.1671-9638.20211152.
[17] 徐金燕, 夏聪聪, 杨红美. 老年脑卒中肺部感染风险预测模型的建立及验证[J]. 实用老年医学, 2024, 38(5): 452-455. DOI:10.3969/j.issn.1003-9198.2024.05.005.

脑梗死患者发生MRSA感染危险因素分析及预测模型构建

Risk factors for MRSA infection in patients with cerebral infarction and establishment of a clinical prediction model

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