Drug Resistance Analysis And Risk Prediction Model Of Multi-Drug Resistant Bacteria Infection In Patients With Ruptured Intracranial Aneurysm Combined With Hospital Acquired Pneumonia

Objective:Retrospective analysis was performed on Ruptured intracranial aneurysm(Ruptured intracranial aneurysm)admitted to the Neurological Intensive Care Unit(NICU)of NORTHERN JIANGSU PEOPLE S HOSPITAL.Distribution,drug resistance,and risk factors of Multidrug-resistant organisms(MDRO)in patients with Hospital acquired pneumonia(HAP);The aim is to understand the infection status of RIA patients with HAP and construct a simple,easy-to-use and effective risk prediction model,which provides theoretical basis for evaluating the risk of MDRO infection in RIA patients with HAP,early identification of risk groups,and rational use of antibiotics.Methods:(1)The detection results of pathogens in lower respiratory tract of patients with RIA and HAP admitted to NICU of NORTHERN JIANGSU PEOPLE S HOSPITAL from January 2018 to December 2022 were retrospectively collected,and the species distribution and drug resistance of pathogens were statistically analyzed.(2)The medical records of patients with RIA combined with HAP who met the inclusion criteria were collected,including basic information(age,gender,history of disease,Glasgow coma scale,etc.),laboratory examination results(red blood cell count,white blood cell count,neutrophil count,and serum albumin value,etc.).And the information about treatment and complications(whether hydrocephalus,venous embolism,cerebrospinal fluid leakage,various invasive procedures,surgical methods and placement of external ventricular drainage devices,etc.).In this study,the patients with MDRO infection in RIA combined with HAP were selected as the experimental group,and those without MDRO infection in the same period were selected as the control group.Univariate analysis was used to compare the differences between the two groups(P<0.05 was considered statistically significant).Multivariate logistic regression analysis was performed based on statistically significant variables to obtain the independent risk factors of MDRO infection.In addition,based on these risk factors,we will establish a risk nomogram prediction model for the early prediction of MDRO infection in RIA patients with HAP.The performance of the model was evaluated by the Area Under the ROC Curve(AUC),and the calibration curve was drawn by the bootstrap method to observe whether the predicted and actual infection probabilities were the same.Decision Curve Analysis(DCA)was used to evaluate the clinical application of the prediction model.Results:(1)Characteristics of the overall composition of the MDRO:A total of 328 eligible RIA patients with HAP were included in this study,of which 87 patients were infected with the MDRO,with an infection rate of 26.5%.Among all MDRO strains,35(34.31%)of Gram-negative bacteria were Multidrug-resistant Klebsiella pneumoniae(MDR-KP).Next was Multidrug-resistant Acinetobacter baumannii(MDR-AB)(n=28,27.45%);All the multi-drug resistant Gram-positive bacteria were Methicillin-resistant Staphylococcus aureus(MRSA),with a total of 22 strains(21.57%).(2)The timing and seasonal distribution of MDRO infection:From January 2018 to December 2022,102 MDRO strains were detected,and the detection rate increased first,then decreased and then increased.The highest amount was detected in 2019(n=29,28.40%),and the lowest amount was detected in 2020(n=15,14.71%).The incidence of MDRO infection is lowest in fall(n=12,11.76%)and highest in winter(n=42,41.18%).The detection rates of MDR-KP and MDR-AB decreased in recent two years.The detection rate of Multi-resistant Pseudomonas aeruginosa(MDR-PA)and MRSA has been on the rise in the past two years.(3)MDRO Resistance status:The resistance rate of MRSA to penicillin and benzacillin was 100%;the resistance rate to erythromycin and Lincomycin was over 45%;the resistance rate to levofloxacin,ciprofloxacin and moxifloxacin were 22.73%,4.5%and 18.18%,respectively;no cefoxitin,ceflorin,Linezolid and vancomycin strains were found.The resistance rate of MDR-KP to all β-lactam antibiotics was more than 85%,to all quinolones antibiotics was more than 80%,to tetracycline antibiotics except tigacycline(25.71%)was more than 85%,and to polymyxin(2.85%)and amikacin(17.14%)was lower.The resistance rate of MDR-AB to all β-lactam antibiotics was more than 85%,to all quinolones antibiotics was more than 78%,to tetracycline antibiotics except tigacycline(10.71%),to amicacin was more than 80%,and no polymycin resistance was detected.The resistance rate of MDR-PA to the first generation,the second generation and part of the third generation cephalosporin antibiotics was more than 93%,the resistance rate of all carbapenems antibiotics was more than 80%,the resistance rate of penicillin and quinolone antibiotics was more than 86%,the resistance rate of tetracycline antibiotics was more than 86%,and the resistance rate of amicacin was 6.66%.No polymyxin-resistant strains were detected.(4)A total of 30 risk factors including age,gender,disease history and Glasgow coma scale were included to construct the prediction model.Univariate analysis showed that 13 risk factors including diabetes mellitus(P<0.001),GCS score ≤ 8(P<0.001),hydrocephalus(P<0.001)were associated with MDRO infection(P<0.05).Multivariate Logistic regression analysis showed that:Diabetes mellitus(P=0.032),tracheotomy(P=0.004),history of mechanical ventilation(P=0.033),low albumin level(P<0.001),hydrocephalus(P<0.001)and Glasgow Coma Scale at admission(P<0.001).GCS≤8(P=0.032)was the independent risk factor for MDRO infection.The prediction model based on multivariate regression results had good discrimination(the area under the ROC curve of the training set was 0.842,and the area under the ROC curve of the validation set was 0.838)and calibration(the slope of the validation set and the training set were both 1.000).Decision Curve Analysis(DCA)showed that the nomogram model had the best applicability when the threshold of MDRO infection was between 10%and 97%,which had certain clinical application value.Conclusions:(1)The infection rate of MDRO in RIA combined with HAP patients was 26.5%,and the incidence was higher in winter.In addition,MDR-KP and MDR-AB were the main strains,and there was a downward trend in recent years.(2)MRSA was highly resistant to antibiotics except cefoxitin,ceftaroline,linezolid and vancomycin.Linezolid and vancomycin were the first choice for the treatment of MRSA infection.Multi-drug resistant Gram-negative bacteria were resistant to most antibiotics.The combination of polymyxin and tigecycline and amikacin were the preferred treatment for MDR-KP,MDR-AB and MDR-PA,respectively.(3)This study found that hydrocephalus,low albumin level,diabetes mellitus,coma(GCS≤8 points),tracheotomy and mechanical ventilation were independent risk factors for MDRO infection in patients with RIA complicated with HAP.The prediction model established in this study can help clinicians early identify and screen high-risk patients of MDRO infection,and provide a simple,easy to use,and effective prediction tool for reducing MDRO infection and early intervention.