To establish a risk prediction model for carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in intestinal carriers.
CRE screenings were performed every two weeks in hematology department and intensive care unit (ICU). Patients with positive CRE rectal swab screening were identified using electronic healthcare records from 15 May 2018 to 31 December 2019. All CRE strains were collected and identified. Carriers who developed CRE BSI were compared with those who did not develop CRE infection. The control group 1:1 stratified randomly matched the case group. Univariate logistic analysis, multivariate logistic analysis and stepwise regression analysis were carried out.
A total of 42 cases were included. Multivariate analysis showed that gastrointestinal injury (OR 86.82, 95%CI 2.58-2916.59, P = 0.013), tigecycline exposure (OR 14.99, 95%CI 1.82-123.74 P = 0.012) and carbapenem resistance score (OR 11.24, 95% CI 1.81–69.70, P = 0.009) were independent risk factors for CRE BSI in intestinal carriers (P < 0.05). They were included in the Logistic regression model to predict BSI. According to receiver operating characteristic (ROC) curve analysis, the cut-off value of the model was 0.72, and the sensitivity, specificity and area under the curve (AUC) were 90.5%, 85.7% and 0.92, respectively.
The risk prediction model based on gastrointestinal injury, tigecycline exposure and carbapenem resistance score of colonizing strain can effectively predict CRE BSI in patients with CRE colonization. Early CRE screening and detection for inpatients in key departments may early warning and reduce the risk of nosocomial infection of CRE.