碳青霉烯类耐药肺炎克雷伯菌感染的危险因素分析及列线图预测模型的构建

doi:10.3969/j.issn.1006-5725.2026.03.016

Abstract

Abstract:

Objective To analyze the independent risk factors for carbapenem-resistant Klebsiella pneumoniae （carbapenem-resistant Klebsiella pneumoniae，CRKP） infection in clinical patients， and further establish a nomogram model applicable for individualized risk prediction. Methods Clinical data of 422 patients with Klebsiella pneumoniae infection admitted to Chaohu Hospital Affiliated to Anhui Medical University from January 2023 to June 2025 were collected retrospectively. Using R software， the data were randomly split into a training set （295 cases） and a validation set （127 cases） at a ratio of 7∶3. LASSO and Logistic regression were used to identify risk factors， and a nomogram for the CRKP infection risk prediction model was further constructed with its performance analyzed. Results Multivariate analysis revealed five independent risk factors for CRKP infection in patients， namely ICU admission （OR = 4.883， 95%CI： 1.842 ~ 12.946）， tracheotomy/tracheal intubation （OR = 4.784， 95%CI： 1.763 ~ 12.981）， sputum aspiration （OR = 2.309， 95%CI： 0.767 ~ 6.954）， carbapenem administration （OR = 4.832， 95%CI： 1.944 ~ 12.009）， and combined antibacterial agent use （OR = 2.239， 95%CI： 0.938 ~ 5.341）. Subsequently， a prediction model was established based on these five variables screened from the training set， with the formula expressed as： Logit（P） = -3.632 + ［ICU admission （yes = 1， no = 0）］× 1.586 + ［Carbapenem use （yes = 1， no = 0）］× 1.575 + ［combined use of antibiotics （yes = 1， no = 0）］× 0.806 + ［sputum suction （yes = 1， no = 0）］× 0.837 + ［tracheotomy/tracheal intubation （yes = 1， n o =0）］× 1.565. The area under the receiver operating characteristic curve （AUC） was 0.921 （95% confidence interval ［CI］： 0.880~0.961） in the training set and 0.914 （95% CI： 0.846 ~ 0.983） in the validation set. The calibration curves generated for both the training set and validation set in this study demonstrated favorable consistency between the probability of CRKP infection predicted by the established model and the actual CRKP infection probability observed in clinical practice. The Hosmer-Lemeshow （H-L） test indicated that the model had a good degree of calibration. Decision curve analysis （DCA） further validated the favorable clinical utility of the constructed model. Conclusion The constructed risk prediction model can well predict high-risk patients with CRKP infection and can be used as a tool to assess the risk of CRKP infection in hospitalized patients.

Key words: carbapenem-resistant Klebsiella pneumoniae, risk factor analysis, nomogram, prediction model

CLC Number:

R563.1

Mengyuan WANG,Fanliang MENG. Analysis of risk factors for carbapenem-resistant Klebsiella pneumoniae infection and construction of a nomogram prediction model[J]. The Journal of Practical Medicine, 2026, 42(3): 477-485.

Figures/Tables 7

Tab.1

Comparison of clinical characteristics between the training set and validation set for the CRKP infection riskprediction model"

临床资料	训练集（n = 295）	验证集（n = 127）	t/Z/χ²值	P值
年龄（x ± s）/岁	71.00 ± 13.43	69.88 ± 11.36	0.818	0.414
性别			0.284	0.594
男	221（74.92）	92（72.44）
女	74（25.08）	35（27.56）
住院时间［M（P₂₅，P₇₅）］/d	13.00（10.00，19.00）	13.00（9.00，18.00）	-0.485	0.628
入住ICU	102（34.58）	41（32.28）	0.208	0.648
合并基础疾病
高血压	121（41.02）	55（43.31）	0.192	0.662
糖尿病	94（31.86）	36（28.35）	0.515	0.473
心血管疾病	86（29.15）	41（32.28）	0.414	0.520
脑血管疾病	100（33.90）	48（37.80）	0.592	0.442
慢性肺病	61（20.68）	25（19.69）	0.054	0.816
恶性实体肿瘤	57（19.32）	29（22.83）	0.675	0.411
手术史	162（54.92）	73（57.48）	0.237	0.627
抗菌药物使用情况
加酶抑制剂	178（60.34）	81（63.78）	0.443	0.506
头孢菌素类	140（47.46）	58（45.67）	0.114	0.736
碳青霉烯类	70（23.73）	32（25.20）	0.104	0.747
喹诺酮类	98（33.22）	46（36.22）	0.355	0.551
氨基糖苷类	15（5.08）	5（3.94）	0.259	0.611
四环素类	25（8.47）	7（5.51）	1.112	0.292
万古霉素	16（5.42）	7（5.51）	0.001	0.971
联合使用抗生素	119（40.34）	53（41.73）	0.071	0.789
侵入性操作
吸痰	110（37.29）	49（38.58）	0.063	0.801
气管切开或插管	69（23.39）	27（21.26）	0.229	0.632
机械通气	79（26.78）	30（23.62）	0.462	0.497
留置导尿管	151（51.19）	62（48.82）	0.199	0.655
留置胃管	108（36.61）	48（37.80）	0.054	0.817
深静脉置管	61（20.68）	23（18.11）	0.367	0.545
血液透析	9（3.05）	6（4.72）	0.725	0.394
WBC［M（P₂₅，P₇₅）］/（× 10⁹/L）	9.44（6.71，13.67）	8.83（6.24，12.03）	-1.432	0.152
N% ［M（P₂₅，P₇₅）］/%	81.90（74.20，88.10）	81.40（71.50，87.50）	-0.842	0.400
NEU［M（P₂₅，P₇₅）］/（× 10⁹/L）	7.70（4.82，12.11）	7.01（4.42，10.39）	-1.351	0.177
LYM［M（P₂₅，P₇₅）］/（× 10⁹/L）	0.98（0.65，1.39）	0.98（0.63，1.35）	-0.524	0.600
RBC（x ± s）/（× 10¹²/L）	3.56 ± 0.86	3.66 ± 0.84	-1.130	0.259
ALB［M（P₂₅，P₇₅）］/（g/L）	35.20（31.00，37.60）	34.60（31.60，37.40）	-0.264	0.792
NLR［M（P₂₅，P₇₅）］	7.75（4.46，14.19）	7.70（3.92，13.86）	-0.123	0.902

Tab.1

Fig.1

Tab.2

Fig.2

Fig.3

Fig.4

Fig.5

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Analysis of risk factors for carbapenem-resistant Klebsiella pneumoniae infection and construction of a nomogram prediction model

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自变量	β	S.E	Wald	P值	OR	95%CI
入住ICU	1.586	0.497	3.188	0.001	4.883	1.842 ~ 12.946
碳青霉烯类药物	1.575	0.465	3.392	< 0.001	4.832	1.944 ~ 12.009
联合使用抗生素	0.806	0.444	1.817	0.069	2.239	0.938 ~ 5.341
吸痰	0.837	0.562	1.488	0.137	2.309	0.767 ~ 6.954
气管切开或插管	1.565	0.509	3.074	0.002	4.784	1.763 ~ 12.981

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