Abstract:Objective To create a model to predict nosocomial infections in emergency intensive care units (EICU), so as to provide insights into early identification and interventions among patients with nosocomial infections. Methods All nosocomial infections were collected from patients hospitalized in the EICU of a large tertiary hospital from 2017 to 2020. The 2017-2019 data were selected as the training set to create a logistic regression model, and the fitting effectiveness of the predictive model was evaluated using Hosmer-Lemeshow test. The 2020 data were selected as the test set to evaluate the external validation of the predictive model. In addition, the value of the model for prediction of nosocomial infections was examined using the receiver operating characteristic (ROC) curve analysis. Results Totally 1 546 inpatients in EICU were enrolled, and the prevalence of nosocomial infections was 7.18%. Multivariable logistic regression analysis identified hospital stay duration of >7 days (OR=21.845, 95%CI: 7.901-60.398), use of ventilators (OR=3.405, 95%CI: 1.335-8.682), and surgery (OR=1.854, 95%CI: 1.121-3.064) as risk factors of nosocomial infections. The predictive model was p=ey/(1+ey), y=-6.105+(3.084×duration of hospital stay)+(1.225×use of ventilators)+(0.617×surgery). The area under ROC curve was 0.806 (95%CI: 0.774-0.838) for the training set and 0.723 (95%CI: 0.623-0.823) for the test set, and if the 0.065 cut-off of the predictive model created by the training set was included in the test set, the predictive value yield a 0.739 sensitivity and 0.642 specificity for prediction of nosocomial infections among patients hospitalized in EICU. Conclusion The created predictive model for nosocomial infections among patients hospitalized in EICU presents a high accuracy, which shows a satisfactory predictive value for high-risk nosocomial infections.
何亚盛, 张红霞, 倪银, 朱越燕, 彭敏, 杨丹红. 急诊重症监护病房住院患者医院感染的预测模型研究[J]. 预防医学, 2022, 34(9): 919-922.
HE Yasheng, ZHANG Hongxia, NI Yin, ZHU Yueyan, PENG Min, YANG Danhong. A model to predict nosocomial infections among inpatients in emergency intensive care units. Preventive Medicine, 2022, 34(9): 919-922.
[1] 张敏璐,刘菁,张静,等.“网底式”管理在急诊重症监护病房老年患者器械相关感染防控中的效果研究[J].华西医学,2022,37(3):357-362. ZHANG M L,LIU J,ZHANG J,et al.Effect of “net bottom” management in the prevention and control of device-associated infections in elderly patients in emergency intensive care unit[J].West China Med J,2022,37(3):357-362. [2] COMAS-GARCÍA A,AGUILERA-MARTÍNEZ J I,ESCALANTE-PADRÓN F J,et al.Clinical impact and direct costs of nosocomial respiratory syncytial virus infections in the neonatal intensive care unit[J].Am J Infect Control,2020,48(9):982-986. [3] 孙菲菲,楼晓红,虞洪斌.放射治疗患者医院感染的影响因素分析[J].预防医学,2022,34(5):515-518. SUN F F,LOU X H,YU H B.Influencing factors of nosocomial infections among radiotherapy patients[J].Prev Med,2022,34(5):515-518. [4] ZHAO X,WANG L,WEI N,et al.Risk factors of health care-associated infection in elderly patients:a retrospective cohort study performed at a tertiary hospital in China[J/OL].BMC Geriatr,2019,19(1)[2022-06-24].https://doi.org/10.1186/s12877-019-1208-x. [5] YAMAKAWA K,TASAKI O,FUKUYAMA M,et al.Assessment of risk factors related to healthcare-associated methicillin-resistant Staphylococcus aureus infection at patient admission to an intensive care unit in Japan[J/OL].BMC Infect Dis,2011,11[2022-06-24].http://www.biomedcentral.com/1471-2334/11/303. [6] PATTY C M,SANDIDGE-RENTERIA A,ORIQUE S,et al.Incidence and predictors of nonventilator hospital-acquired pneumonia in a community hospital[J].J Nurs Care Qual,2021,36(1):74-78. [7] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):61-67. Ministry of Health of the people's Republic of China.Diagnostic criteria for nosocomial infection(proposed)[J].Chin J Med,2001,81(5):61-67. [8] 刘红秀,王静喆,杨晶,等.EICU医院感染患者死亡危险因素与干预分析[J].中华医院感染学杂志,2016,26(7):1492-1494. LIU H X,WANG J Z,YANG J,et al.Risk factors and intervention of deaths among EICU patients with nosocomial infections[J].Chin J Nosocomial Infection,2016,26(7):1492-1494. [9] 张辅铭. 从最大似然原理拓宽logistic多元回归应用的探讨[J].中国卫生统计,1995,22(2):40-42. ZHANG F M.Discussion on broadening the application of multivariate logistic regression based on the principle of maximum likelihood[J].Chin J Health Stat,1995,22(2):40-42. [10] 柯小云,童金英,许继涛,等.老年脑梗死长期卧床患者医院感染细菌学及其风险预测模型[J].中华医院感染学杂志,2022,32(7):994-998. KE X Y,TONG J Y,XU J T,et al.Bacteriology of nosocomial infections and prediction model in elderly long-term bedridden patients with cerebral infarction[J].Chin J Nosocomiol,2022,32(7):994-998. [11] 姬海燕,王红霞,窦学梅.综合医院重症监护病房医院感染目标性监测分析[J].天津护理,2020,28(2):205-207. JI H Y,WANG H X,DOU X M.Analysis of targeted surveillance of nosocomial infection in intensive care unit of general hospital[J].Tianjin J Nurs,2020,28(2):205-207. [12] YUE D,SONG C,ZHANG B,et al.Hospital-wide comparison of health care-associated infection among 8 intensive care units:a retrospective analysis for 2010-2015[J].Am J Infect Control,2017,45(1):e7-e13. [13] 储文杰,金凯玲,林凯,等.杭州市某医院住院治疗患者医院感染现患率调查[J].预防医学,2018,30(8):834-836,840. CHU W J,JIN K L,LIN K,et al.Investigation on the prevalence of nosocomial infection among hospitalized patients in a hospital in Hangzhou[J].Prev Med,2018,30(8):834-836,840. [14] ZHOU S K,LE H N,LUU K,et al.Deep reinforcement learning in medical imaging:a literature review[J/OL].Med Image Anal,2021,73[2022-06-24].https://doi.org/10.1016/j.media.2021.102193. [15] 章涛,官海滨,李傅冬,等.应用Elman神经网络建立流感样病例预测模型[J].预防医学,2019,31(2):113-118. ZHANG T,GUAN H B,LI F D,et al.Modeling of influenza-like illness prediction based on Elman neural network[J].Prev Med,2019,31(2):113-118.