Development of a Risk Prediction Model of Subsequent Bloodstream Infection After Carbapenem-Resistant Enterobacteriaceae Isolated from Perianal Swabs in Hematological Patients

Jia Liu; Haixiao Zhang; Dan Feng; Jiali Wang; Mingyang Wang; Biao Shen; Yigeng Cao; Xiaoyu Zhang; Qingsong Lin; Fengkui Zhang; Yizhou Zheng; Zhijian Xiao; Xiaofan Zhu; Lei Zhang; Jianxiang Wang; Aiming Pang; Mingzhe Han; Sizhou Feng; Erlie Jiang

doi:10.2147/IDR.S400939

Development of a Risk Prediction Model of Subsequent Bloodstream Infection After Carbapenem-Resistant Enterobacteriaceae Isolated from Perianal Swabs in Hematological Patients

Infect Drug Resist. 2023 Mar 6:16:1297-1312. doi: 10.2147/IDR.S400939. eCollection 2023.

Authors

Jia Liu¹, Haixiao Zhang¹, Dan Feng¹, Jiali Wang¹, Mingyang Wang¹, Biao Shen¹, Yigeng Cao¹, Xiaoyu Zhang¹, Qingsong Lin¹, Fengkui Zhang¹, Yizhou Zheng¹, Zhijian Xiao¹, Xiaofan Zhu¹, Lei Zhang¹, Jianxiang Wang¹, Aiming Pang¹, Mingzhe Han¹, Sizhou Feng¹, Erlie Jiang¹

Affiliation

¹ State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China.

Abstract

Purpose: Patients with hematological diseases are at high risk of carbapenem-resistant Enterobacteriaceae (CRE) infection, and CRE-related bloodstream infection (BSI) is associated with high mortality risk. Therefore, developing a predictive risk model for subsequent BSI in hematological patients with CRE isolated from perianal swabs could be used to guide preventive strategies.

Methods: This was a single-center retrospective cohort study at a tertiary blood diseases hospital, including all hematological patients hospitalized from 10 October 2017 to 31 July 2021. We developed a predictive model using multivariable logistic regression and internally validated it using enhanced bootstrap resampling.

Results: Of 421 included patients with CRE isolated from perianal swabs, BSI due to CRE occurred in 59. According to the multivariate logistic analysis, age (OR[odds ratio]=1.04, 95% CI[confidence interval]: 1.01-1.06, P=0.004), both meropenem and imipenem minimal inhibitory concentration (MIC) of the isolate from perianal swabs>8ug/mL (OR=5.34, 95% CI: 2.63-11.5, P<0.001), gastrointestinal symptoms (OR=3.67, 95% CI: 1.82-7.58, P<0.001), valley absolute neutrophil count (10⁹/L)>0.025 (OR=0.07, 95% CI: (0.02-0.19, P<0.001) and shaking chills at peak temperature (OR=6.94, 95% CI: (2.60-19.2, P<0.001) were independently associated with CRE BSI within 30 days and included in the prediction model. At a cut-off of prediction probability ≥ 21.5% the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 79.7%, 85.6%, 96.27% and 47.47%. The discrimination and calibration of the prediction model were good on the derivation data (C-statistics=0.8898; Brier score=0.079) and enhanced bootstrapped validation dataset (adjusted C-statistics=0.881; adjusted Brier score=0.083). The risk prediction model is freely available as a mobile application at https://liujia1992.shinyapps.io/dynnomapp/.

Conclusion: A prediction model based on age, meropenem and imipenem MIC of isolate, gastrointestinal symptoms, valley absolute neutrophil count and shaking chills may be used to better inform interventions in hematological patients with CRE isolated from perianal swabs.

Keywords: bloodstream infection; carbapenem-resistant Enterobacteriaceae; hematological patients; perianal colonization; risk prediction model.