Antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae infection in patients with severe traumatic brain injury and construction of a nomogram model

doi:10.3969/j.issn.1004-583X.2026.03.003

Abstract

Abstract:

Objective To analyze the antimicrobial resistance profile of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from neurosurgical patients with severe traumatic brain injury (sTBI), to identify independent risk factors for CRKP infection in this population, and to construct a nomogram for individualized risk prediction. Methods We retrospectively enrolled 524 sTBI patients admitted to the Department of Neurosurgery, Ganzhou People's Hospital, between September 2019 and September 2024. Patients were grouped by CRKP infection status into a CRKP infection group (n=95) and a non-CRKP infection group (n=429). Antimicrobial susceptibility of CRKP isolates was analyzed. Variables showing statistically significant differences between the two groups were entered into multivariable logistic regression to identify independent risk factors. A nomogram based on these independent predictors was developed to estimate the risk of CRKP infection. Model discrimination was assessed by receiver operating characteristic (ROC) curve and area under the curve (AUC); calibration was evaluated with a calibration curve. Results Antimicrobial susceptibility testing showed high resistance rates of CRKP to commonly used antibiotics, while resistance rates to tigecycline and ceftazidime-avibactam were 0%. Between the two groups, the proportions of patients with age ≥60 years, hospital stay ≥30 days, operative time ≥60 minutes, number of operations ≥2, postoperative prophylactic antibiotics after first surgery, antibiotic exposure ≥30 days, combination antibiotic therapy, use of ≥3 antibiotic agents, admission GCS ≤5, coma, tracheotomy, mechanical ventilation, indwelling urinary catheter, central venous catheter, indwelling gastric tube, repeat catheterization, fever ≥10 days, blood transfusion, hypoproteinemia, and use of immunosuppressants or steroids differed significantly (all P<0.05). Multivariable logistic regression identified the following independent risk factors for CRKP infection in neurosurgical sTBI patients: age ≥60 years, antibiotic exposure ≥30 days, use of ≥3 antibiotic classes, indwelling urinary catheter, indwelling gastric tube, fever ≥10 days, blood transfusion, and hypoproteinemia (all P<0.05). A nomogram constructed from these predictors yielded an AUC of 0.965(95%CI: 0.950-0.980, P<0.05), with sensitivity 0.895 and specificity 0.944. The calibration curve showed good agreement between predicted and observed risks. Conclusion Age ≥60 years, prolonged antibiotic exposure (≥30 days), use of multiple antibiotic classes (≥3), indwelling urinary catheter, indwelling gastric tube, prolonged fever (≥10 days), blood transfusion, and hypoproteinemia are independent risk factors for CRKP infection in neurosurgical patients with sTBI. The nomogram based on these factors demonstrates excellent discriminative ability and good calibration.

Key words: craniocerebral trauma, Klebsiella pneumoniae, predictive model, nomograms, drug resistance

CLC Number:

R651

Liao Yuning, Zhong Meixing, Lin Xiaofang. Antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae infection in patients with severe traumatic brain injury and construction of a nomogram model[J]. Clinical Focus, 2026, 41(3): 212-218.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2026.03.003

https://www.lchc.cn/EN/Y2026/V41/I3/212

Figures/Tables 6

References 33

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抗菌药物	2019年9月- 2020年9月(n=9)		2020年10月- 2021年9月(n=5)		2021年10月- 2022年9月(n=5)		2022年10月- 2023年9月(n=23)		2023年10月- 2024年9月(n=53)		χ²值	P值
抗菌药物	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	χ²值	P值
阿米卡星	0	0.00	4	80.00	1	20.00	18	78.26	53	100.00	60.543	<0.01
阿莫西林克拉维酸	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
厄他培南	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
复方新诺明	0	0.00	0	0.00	0	0.00	22	95.65	50	94.34	66.333	<0.01
替加环素	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	/	/
头孢曲松	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢他啶	8	88.89	5	100.00	5	100.00	22	95.65	53	100.00	33.250	<0.01
头孢西丁	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢呋辛	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢吡肟	7	77.78	3	60.00	3	60.00	23	100.00	53	100.00	33.048	<0.01
头孢哌酮舒巴坦	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
亚胺培南	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
左氧氟沙星	2	22.22	3	60.00	3	60.00	22	95.65	53	100.00	51.482	<0.01
哌拉西林他唑巴坦	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢他啶阿维巴坦	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	/	/

抗菌药物	2019年9月- 2020年9月(n=9)		2020年10月- 2021年9月(n=5)		2021年10月- 2022年9月(n=5)		2022年10月- 2023年9月(n=23)		2023年10月- 2024年9月(n=53)		χ²值	P值
抗菌药物	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	耐药株数 (例)	耐药率	χ²值	P值
阿米卡星	0	0.00	4	80.00	1	20.00	18	78.26	53	100.00	60.543	<0.01
阿莫西林克拉维酸	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
厄他培南	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
复方新诺明	0	0.00	0	0.00	0	0.00	22	95.65	50	94.34	66.333	<0.01
替加环素	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	/	/
头孢曲松	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢他啶	8	88.89	5	100.00	5	100.00	22	95.65	53	100.00	33.250	<0.01
头孢西丁	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢呋辛	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢吡肟	7	77.78	3	60.00	3	60.00	23	100.00	53	100.00	33.048	<0.01
头孢哌酮舒巴坦	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
亚胺培南	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
左氧氟沙星	2	22.22	3	60.00	3	60.00	22	95.65	53	100.00	51.482	<0.01
哌拉西林他唑巴坦	9	100.00	5	100.00	5	100.00	23	100.00	53	100.00	47.368	<0.01
头孢他啶阿维巴坦	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00	/	/

项目	CRKP感染组(n=95)	非CRKP感染组(n=429)	χ²值		P值
年龄≥60岁	43(45.26)	129(30.07)	7.468		0.006
男性	70(73.68)	312(72.73)	0.004		0.950
BMI≥24 kg/m²	31(32.63)	164(38.23)	0.817		0.366
吸烟史	21(22.11)	118(27.51)	0.903		0.342
饮酒史	21(22.11)	63(14.69)	2.654		0.103
住院时间≥30 d	73(76.84)	88(20.51)	113.313		<0.01
高血压史	34(35.79)	112(26.11)	3.162		0.075
糖尿病史	14(14.74)	72(16.78)	0.112		0.738
肿瘤	17(17.89)	44(10.26)	3.700		0.054
手术	72(75.79)	218(50.82)	3.700		0.054
手术时间≥60 min	72(75.79)	199(46.39)	25.763		<0.01
手术次数≥2次	39(41.05)	32(7.46)	72.091		<0.01
首次手术是否术后预防用药	74(77.89)	191(44.52)	33.331		<0.01
抗菌药物使用时间≥30 d	67(70.53)	59(13.75)	134.170		<0.01
联合使用抗菌药物	80(84.21)	94(21.91)	133.306		<0.01
使用抗菌药物种类≥3种	81(85.26)	66(15.38)	184.720		<0.01
入院GCS评分≤5分	79(83.16)	196(45.69)	42.298		<0.01
昏迷	81(85.26)	299(69.70)	8.692		0.003
气管切开	65(68.42)	76(17.72)	99.111		<0.01
呼吸机	85(89.47)	243(56.64)	34.416	<0.01
留置导尿管	89(93.68)	254(59.21)	39.377	<0.01
中心静脉置管	77(81.05)	243(56.64)	20.164	<0.01
留置胃管	80(84.21)	94(21.91)	133.306	<0.01
二次置管	40(42.11)	55(12.82)	42.987	<0.01
发热≥10 d	72(75.79)	47(10.96)	182.582	<0.01
输血	75(78.95)	123(28.67)	81.503	<0.01
低蛋白血症	86(90.53)	190(44.29)	64.860	<0.01
使用免疫抑制剂或激素	56(58.95)	190(44.29)	6.134	0.013

项目	CRKP感染组(n=95)	非CRKP感染组(n=429)	χ²值		P值
年龄≥60岁	43(45.26)	129(30.07)	7.468		0.006
男性	70(73.68)	312(72.73)	0.004		0.950
BMI≥24 kg/m²	31(32.63)	164(38.23)	0.817		0.366
吸烟史	21(22.11)	118(27.51)	0.903		0.342
饮酒史	21(22.11)	63(14.69)	2.654		0.103
住院时间≥30 d	73(76.84)	88(20.51)	113.313		<0.01
高血压史	34(35.79)	112(26.11)	3.162		0.075
糖尿病史	14(14.74)	72(16.78)	0.112		0.738
肿瘤	17(17.89)	44(10.26)	3.700		0.054
手术	72(75.79)	218(50.82)	3.700		0.054
手术时间≥60 min	72(75.79)	199(46.39)	25.763		<0.01
手术次数≥2次	39(41.05)	32(7.46)	72.091		<0.01
首次手术是否术后预防用药	74(77.89)	191(44.52)	33.331		<0.01
抗菌药物使用时间≥30 d	67(70.53)	59(13.75)	134.170		<0.01
联合使用抗菌药物	80(84.21)	94(21.91)	133.306		<0.01
使用抗菌药物种类≥3种	81(85.26)	66(15.38)	184.720		<0.01
入院GCS评分≤5分	79(83.16)	196(45.69)	42.298		<0.01
昏迷	81(85.26)	299(69.70)	8.692		0.003
气管切开	65(68.42)	76(17.72)	99.111		<0.01
呼吸机	85(89.47)	243(56.64)	34.416	<0.01
留置导尿管	89(93.68)	254(59.21)	39.377	<0.01
中心静脉置管	77(81.05)	243(56.64)	20.164	<0.01
留置胃管	80(84.21)	94(21.91)	133.306	<0.01
二次置管	40(42.11)	55(12.82)	42.987	<0.01
发热≥10 d	72(75.79)	47(10.96)	182.582	<0.01
输血	75(78.95)	123(28.67)	81.503	<0.01
低蛋白血症	86(90.53)	190(44.29)	64.860	<0.01
使用免疫抑制剂或激素	56(58.95)	190(44.29)	6.134	0.013

因素	回归系数	标准误	Waldχ²值	OR值	95%CI	P值
截距	-6.332	0.993	40.701
年龄≥60岁	1.465	0.486	9.086	4.329	1.670~11.226	0.003
抗菌药物使用时间≥30 d	1.625	0.687	5.592	5.081	1.321~19.544	0.018
使用抗菌药物种类≥3种	1.767	0.779	5.142	5.854	1.271~26.965	0.023
留置导尿管	2.456	0.849	8.368	11.661	2.208~61.590	0.004
留置胃管	3.186	0.842	14.310	24.179	4.641~125.962	<0.01
发热≥10 d	2.835	0.525	29.210	17.032	6.092~47.619	<0.01
输血	2.184	0.617	12.529	8.884	2.651~29.779	<0.01
低蛋白血症	1.334	0.620	4.631	3.795	1.126~12.788	0.031