Abstract：
With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis.
METHODS: We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility.
RESULTS: The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model\'s predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%).
CONCLUSIONS: This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.
METHODS: We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility.
RESULTS: The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model\'s predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%).
CONCLUSIONS: This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.
摘要：
随着多药耐药菌（MDRO）感染率的增加，选择合适的经验性抗生素已成为挑战。我们旨在开发和外部验证预测肝硬化患者MDRO感染风险的模型。
方法：我们从两项前瞻性研究中纳入了肝硬化和细菌感染的患者：一项跨大陆研究用于模型开发和内部验证（n=1302），来自阿根廷和乌拉圭的一项研究用于外部验证(n=472)。在感染时测量所有预测因子。包括培养阳性和培养阴性感染。该模型是使用逻辑回归和向后逐步预测因子选择建立的。我们使用校准和歧视统计从外部验证了乐观调整模型，并评估了其临床实用性。
结果：在开发和外部验证数据集中，MDRO感染的患病率分别为19%和22%，分别。模型的预测因素是性别，以前使用抗生素，感染的类型和部位，MELD-Na,使用血管升压药，慢性急性肝衰竭,和互动术语。在外部验证时，校准斜率为77（95%CI.48-1.05），ROC曲线下面积为.68（95%CI.61-.73）。该模型的应用显着改变了MDRO感染的后验概率，确定医院感染风险极低的患者(8%)和社区获得性感染风险显著的患者(36%).
结论：该模型取得了足够的性能，可用于改善经验性抗生素的选择，与其他抗生素管理计划战略保持一致。
方法：我们从两项前瞻性研究中纳入了肝硬化和细菌感染的患者：一项跨大陆研究用于模型开发和内部验证（n=1302），来自阿根廷和乌拉圭的一项研究用于外部验证(n=472)。在感染时测量所有预测因子。包括培养阳性和培养阴性感染。该模型是使用逻辑回归和向后逐步预测因子选择建立的。我们使用校准和歧视统计从外部验证了乐观调整模型，并评估了其临床实用性。
结果：在开发和外部验证数据集中，MDRO感染的患病率分别为19%和22%，分别。模型的预测因素是性别，以前使用抗生素，感染的类型和部位，MELD-Na,使用血管升压药，慢性急性肝衰竭,和互动术语。在外部验证时，校准斜率为77（95%CI.48-1.05），ROC曲线下面积为.68（95%CI.61-.73）。该模型的应用显着改变了MDRO感染的后验概率，确定医院感染风险极低的患者(8%)和社区获得性感染风险显著的患者(36%).
结论：该模型取得了足够的性能，可用于改善经验性抗生素的选择，与其他抗生素管理计划战略保持一致。
