Risk Factors and Predictive Nomogram for Carbapenem-Resistant Klebsiella pneumoniae in Children in a Grade 3 First-Class General Hospital in Central China

Abstract

Background This study determined risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP)in children admitted to a grade 3 first-class general hospital and developed an individualized line graph predictive model. Methods The clinical data of 185 children infected with Klebsiella pneumoniae from January 2015 to December 2019 were analyzed retrospectively. Patients were grouped according to carbapenem resistance: CRKP group (50 cases) and CSKP (carbapenem-sensitive Klebsiella pneumoniae) group (135 cases). Risk factors for CRKP in children were screened by logistic regression analysis. The predictive model was established using R software and validated using the Bootstrap method. Results Age (odds ratio [OR]=0.104, 95% confidence interval [CI]: 0.026–0.408), intensive care unit admission (OR =2.829, 95% CI: 1.138–7.030), mechanical ventilation (OR =7.510, 95% CI: 3.140–17.961), surgery history (OR =5.005, 95% CI: 1.507–16.618) and glucocorticoid (OR =0.235, 95% CI: 0.099–0.557) were independent risk factors for CRKP in children (P < 0.05), The total risk score of each factor was 362.5, and the risk rate was 0.1–0.9. In receiver-operating characteristic curve analysis, the area under the curve of CRKP predicted by the total risk score was 0.872 (95% CI=0.844–0.901; P < 0.001). The correction curve indicated that the consistency between the observed value and the predicted value was good. Discussion and Conclusion This study successfully established a model based on the risk factors, with high accuracy and good predictive value for CRKP in children. Hospitals should take necessary preventive measures against the risk factors for drug-resistant bacteria, such as optimizing the configuration of ICU space, timely isolation of infected children, and adequate disinfection of ICU equipment. Which may reduce CRKP infection rate.