Development and Validation of a Nomogram Prediction Model for Multidrug-Resistant Organisms Infection in a Neurosurgical Intensive Care Unit

Ya Wang,1,* Jiajia Zhang,2,* Xiaoyan Chen,1,* Min Sun,3 Yanqing Li,4 Yanan Wang,5 Yan Gu,6 Yinyin Cai1 1Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 2Neurosurgery Section Two, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 3Department of Geriatrics Section Three, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 4Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 5Respiratory and Critical Care Medicine Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 6Infection Management Office, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaoyan Chen, Email CXYtdfy@126.comObjective: To develop a predictive model for assessing the risk of multidrug-resistant organisms (MDROs) infection and validate its effectiveness.We conducted a study on a total of 2516 patients admitted to the neurosurgery intensive care unit (NICU) of a Grade-III hospital in Nantong City, Jiangsu Province, China, between January 2014 and February 2022. Patients meeting the inclusion criteria were selected using convenience sampling. The patients were randomly divided into modeling and validation groups in a 7:3 ratio. To address the category imbalance, we employed the Synthetic Minority Over-sampling Technique (SMOTE) to adjust the MDROs infection ratio from 203:1558 to 812:609 in the training set. Univariate analysis and logistic regression analysis were performed to identify risk factors associated with MDROs infection in the NICU. A risk prediction model was developed, and a nomogram was created. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of the model.Patients and Methods: Results: Logistic regression analysis revealed that sex, hospitalization time, febrile time, invasive operations, postoperative prophylactic use of antibiotics, mechanical ventilator time, central venous catheter indwelling time, urethral catheter indwelling time, ALB, PLT, WBC, and L% were independent predictors of MDROs infection in the NICU. The area under the ROC curve for the training set and validation set were 0.880 (95% CI: 0.857– 0.904) and 0.831 (95% CI: 0.786– 0.876), respectively. The model’s prediction curve closely matched the ideal curve, indicating excellent predictive performance.Conclusion: The prediction model developed in this study demonstrates good accuracy in assessing the risk of MDROs infection. It serves as a valuable tool for neurosurgical intensive care practitioners, providing an objective means to effectively evaluate and target the risk of MDROs infection.Keywords: multidrug-resistant, infection, neurosurgical intensive care unit, nomogram