Development of a model to predict the risk of multi-drug resistant organism infections in ruptured intracranial aneurysms patients with hospital-acquired pneumonia in the neurological intensive care unit

Abstract

Objective

This study was developed to explore the incidence of multi-drug resistant organism (MDRO) infections among ruptured intracranial aneurysms(RIA) patient with hospital-acquired pneumonia(HAP) in the neurological intensive care unit (NICU), and to establish risk factors related to the development of these infections.

Methods

We collected clinical and laboratory data from 328 eligible patients from January 2018 to December 2022. Bacterial culture results were used to assess MDRO strain distributions, and risk factors related to MDRO infection incidence were identified through logistic regression analyses. These risk factors were further used to establish a predictive model for the incidence of MDRO infections, after which this model underwent internal validation.

Results

In this study cohort, 26.5 % of RIA patients with HAP developed MDRO infections (87/328). The most common MDRO pathogens in these patients included Multidrug-resistant Klebsiella pneumoniae (34.31 %) and Multidrug-resistant Acinetobacter baumannii (27.45 %). Six MDRO risk factors, namely, diabetes (P = 0.032), tracheotomy (P = 0.004), history of mechanical ventilation (P = 0.033), lower albumin levels (P < 0.001), hydrocephalus (P < 0.001) and Glasgow Coma Scale (GCS) score ≤8 (P = 0.032) were all independently correlated with MDRO infection incidence. The prediction model exhibited satisfactory discrimination (area under the curve [AUC], 0.842) and calibration (slope, 1.000), with a decision curve analysis further supporting the clinical utility of this model.

Conclusions

In summary, risk factors and bacterial distributions associated with MDRO infections among RIA patients with HAP in the NICU were herein assessed. The developed predictive model can aid clinicians to identify and screen high-risk patients for preventing MDRO infections.