Establishment And Validation Of Nomogram Model For The Risk Of Multi-drug Resistant Bacteria Infection And Expioration Infection Status In Ultra-old Patients With Pulmonary Infection

Objective1.To explore the status quo and risk factors of multi-drug resistant bacteria infection in ultra-old patients with pulmonary infection;2.To establishment and validation of Nomogram model for the risk of multi-drug resistant bacteria infection in ultra-old patients with pulmonary infection.MethodsThe clinical data（including age,gender,length of stay,smoking history,drug allergy history,previous surgery history,complications,etc.）of 659 hospitalized patients with positive sputum culture of pulmonary infection in our hospital from January 2017 to December 2019 were retrospectively investigated by using the Hospital Information System（HIS）.150 patients were randomly selected from the original data as the verification set,and the remaining 509 patients were used as the training set.SPSS20.0was used to analyze the independent risk factors of infection with multidrug-resistant bacteria in extremely elderly inpatients with pulmonary infection in the training set by univariate and Logistic multivariate regression,respectively.Then,R 4.0.3 software was used for statistical analysis to build Nomogram prediction model,and verified its prediction,accuracy and benefit.Results1.Data from the training set were divided into MDRB group and non-MDRB group.There were 203 patients in the MDRB group,including 150 males and 53 females.The average age was（86.00 ± 4.46）between 80 and 99 years old.There were 306 patients in the non-MDRB group,including 200 males and 106 females.The average age was（85.85 ± 4.07）years old.There was no significant difference in age structure between the MDR group and the non-mdr group（P > 0.05）.2.830 strains pathogenic bacteria infection were detected in 659 patients,274 patients for MDRB infection,infection rate is 41.58%,check out the MDRB strains in 331 strains,the total strain of 39.88%.In order,the multidrug-resistant strains were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,Staphylococcus aureus,and Sartorius mucilatus.3.Comparison of general clinical data between the multi-drug resistant bacteria group and the non-multi-drug resistant bacteria group showed that there were statistically significant differences in long-term bed rest,respiratory failure,cerebrovascular disease,length of hospitalization ≥ 2 weeks,types of antibacterial drug use ≥ 2 weeks,duration of antibacterial drug use ≥ 2 weeks,sputum aspiration during treatment,endotracheal intubation,indwelling gastric tube,indwelling urinary tube,deep vein indwelling tube,indwelling drainage tube,malnutrition,and number of red blood cells（P < 0.05）.4.Logistic regression analysis showed that infection with multidrug-resistant bacteria was not correlated with long-term bed rest,severe pneumonia,hospitalization duration≥ 2 weeks,antibiotic use ≥ 2 types,sputum aspiration during treatment,indwelling gastric tube,indwelling urethral catheter,deep vein indwelling tube,indwelling drainage tube,etc.However,antibiotic use duration ≥ 2 weeks（OR=1.852,95%CI:1.234～ 2.778）,endotracheal intubation（OR=3.194,95%CI:1.794 ～ 5.686）,respiratory failure（OR=2.102,95%CI:1.231 ～ 3.591）,cerebrovascular disease（OR=1.719,95%CI:1.135 ～2.602）,and malnutrition（OR=3.551,95%CI:1.391-9.067）were independent risk factors for multi-drug resistant bacteria infection in ultra-old patients with pulmonary infection（P < 0.05）,both highly correlated with pulmonary infection with multidrug-resistant bacteria.5.The risk nomogram model was established based on the above five risk factors.The AUC values of the modeling group and the verification group were 0.748 and 0.746 respectively,indicating that the model had good diagnostic ability.Hosmer-lemeshow test（P=0.991 for the modeling group and P=0.348 for the validation group）indicated that the model had a good goodness of fit.The decision curve analysis shows that the model has a higher benefit within a larger threshold.Conclusion1.There are some differences between the analysis results of pulmonary drug-resistant bacterial infection of the super-aged patients in our hospital and the national drug-resistant bacterial survey results.When multi-drug-resistant bacterial infection is encountered in clinical work,we should carefully choose antibiotics in line with our own rules according to the distribution rules of drug-resistant bacteria and drug resistance rates of various antibiotics of ultra-elderly pulmonary infection patients in our hospital.2.For ultra-old patients with pulmonary infection,attention should be paid to the duration of antibiotic use,endotracheal intubation and other risk factors,and the possibility of multi-drug-resistant bacterial infection in ultra-elderly patients with pulmonary infection should be evaluated individually by using the nomogram model,and the corresponding intervention measures should be developed after comprehensive consideration of various indicators.