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Volume 39 Issue 11
Nov.  2023
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2023  >  39(11): 1006-1013
Han C,Ji P,Shang YG,et al.Epidemiological characteristics of nosocomial infection in hospitalized children with burns and the establishment and verification of a risk prediction model[J].Chin J Burns Wounds,2023,39(11):1006-1013.DOI: 10.3760/cma.j.cn501225-20230812-00046.
Citation: Han C,Ji P,Shang YG,et al.Epidemiological characteristics of nosocomial infection in hospitalized children with burns and the establishment and verification of a risk prediction model[J].Chin J Burns Wounds,2023,39(11):1006-1013.DOI: 10.3760/cma.j.cn501225-20230812-00046.
shu

Epidemiological characteristics of nosocomial infection in hospitalized children with burns and the establishment and verification of a risk prediction model

doi: 10.3760/cma.j.cn501225-20230812-00046
  • 1.

    Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

  • 2.

    Department of Wound Repair, Center for Wound Repair and Regenerative Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China

Funds:

General Program of National Natural Science Foundation of China 82272269

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    Abstract
  •   Objective   To analyze the epidemiological characteristics of hospitalized children with burns who developed nosocomial infection, and screen their independent risk factors, based on which, a risk prediction model was established and evaluated.   Methods   A retrospective cohort study was conducted. From May 2010 to April 2023, 417 children with burns who met the inclusion criteria were admitted to the First Affiliated Hospital of the Air Force Medical University, including 248 males and 169 females, aged ≤14 years. Statistics on the composition and source distribution of pathogenic bacteria in children were detected. According to the occurrence of nosocomial infection, the children were divided into infected group (216 cases) and uninfected group (201 cases), and the children gender, age, total area of burns, presence of full-thickness burns, cause of the injury, and season of the injury of the children in the 2 groups were collected, as well as presence of an abnormal serum albumin level, delayed resuscitation, combination of inhalation injury at admission, and early shock, tracheotomy, admission to the intensive care unit, and deep venous catheterization after post-hospitalization, and more or less times (>2 times being more and ≤2 times being less) of surgeries, indwelling catheter days, and length of hospitalization stay on post-hospitalization. The burned children were divided into modeling group (291 cases) and validation group (126 cases) according to the ratio of 7∶3, and the data of the 2 groups were recorded as before. Data were statistically analyzed with Mann-Whitney U test, chi-square test, and Fisher's exact probability test. The least absolute value selection and shrinkage operator (LASSO) regression analysis was used to reduce the risk factors of nosocomial infection in the children in modeling group. Multivariate logistic regression analysis was used to further screen the above screened risk factors, and the nomogram prediction model was drawn based on the further screened independent risk factors. The Bootstrap method was used for internal validation of the aforementioned predictive models, and the receiver operator characteristic (ROC) curves, calibration curves, and clinical decision curves of the predictive models were plotted in modeling group and validation group in order to assess its discriminative power, calibration, and clinical utility, respectively.   Results   A total of 245 strains of pathogenic bacteria were detected, with Staphylococcus aureus (101 strains, accounting for 41%), Pseudomonas aeruginosa (54 strains, accounting for 22%), and Acinetobacter baumannii (33 strains, accounting for 13%) dominating, and the wound secretions were the most frequent source of pathogenic bacteria (211 strains, accounting for 86%), followed by blood (10 strains, accounting for 4%), and sputum (5 strains, accounting for 2%). There were statistically significant differences between infected group and non-infected group in the total burn area, indwelling catheter days, length of hospitalization stay, presence of full-thickness burns, combined with inhalation injury, and deep vein catheterization, and more or less times of surgeries (with Zvalues of -2.32, -3.29, and -3.85, respectively, with χ 2 values of 26.36, 7.03, 10.13, and 10.53, respectively, P<0.05); there was statistically significant difference in cause of the injury between the two groups ( P<0.05). All clinical characteristics of children with burns in the modeling and validation groups were similar ( P>0.05). The six risk factors obtained from the LASSO regression analysis were full-thickness burns, deep vein catheterization, abnormal serum albumin level, multiple surgeries, indwelling catheter days, and length of hospitalization stay; the multivariate logistic regression analysis showed that full-thickness burns, abnormal serum albumin level, deep vein catheterization, and multiple surgeries were the independent risk factors for the occurrence of nosocomial infection in burned children (with odds ratios of 2.27, 2.66, 4.08, and 2.92, respectively, with 95% confidence intervals of 1.22-4.21, 1.03-6.87, 1.07-15.49, and 1.15-7.42, respectively, P<0.05). The ROC curves of the prediction models showed that, the areas under the ROC curves of the modeling and validation groups were 0.81 (with 95% confidence interval of 0.78-0.84) and 0.81 (with 95% confidence interval of 0.76-0.85), respectively; the calibration curves showed that, the calibration curves of the prediction models of modeling and validation groups were around the ideal curves; the clinical decision curves showed that, the threshold probability values of the prediction models in modeling and validation groups were in the ranges of 5% to 70% and 1% to 46%, respectively.   Conclusions   The main pathogen of infection in children with burns is Staphylococcus aureus from wound secretions. A nomogram risk prediction model constructed based on independent risk factors such as full-thickness burns, abnormal serum albumin level, deep venous catheterization, and multiple surgeries has good accuracy and can be easily used to predict the occurrence of nosocomial infections in hospitalized children with burns.

     

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    • References(21)
  • [1]
    ErdoğanH, SencanA. Analysis of the epidemiological features and treatment results of burn injuries in a burn center in Turkey[J]. J Burn Care Res, 2023:irad119. DOI: 10.1093/jbcr/irad119.
    [2]
    潘选良, 朱志康, 沈涛, 等. 特重度烧伤患者发生脓毒症与死亡的流行病学特点和危险因素[J].中华烧伤与创面修复杂志,2023,39(6):558-564. DOI: 10.3760/cma.j.cn501225-20220806-00336.
    [3]
    潘艳艳, 徐思达, 范友芬, 等. 特重度烧伤患者早期肠内营养不耐受的危险因素分析[J].中华烧伤杂志,2021,37(9):831-838. DOI: 10.3760/cma.j.cn501120-20210511-00180.
    [4]
    ChenK, LiuJ, WangX, et al. Epidemiological characteristics of paediatric burn patients in China from 2016 to 2019: a retrospective study[J]. BMJ Paediatr Open, 2023, 7(1):e001796. DOI: 10.1136/bmjpo-2022-001796.
    [5]
    YaoY, MaL, ChenL. Characteristics of injury mechanisms in children and differences between urban and rural areas in central China[J]. Eur J Trauma Emerg Surg, 2023,DOI: 10.1007/s00068-023-02320-x.
    [6]
    陈华桂, 周秀萍. 儿童烧伤患者感染MRSA的耐药性及分子流行病学研究[J].国际检验医学杂志,2014(3):299-300,303. DOI: 10.3969/j.issn.1673-4130.2014.03.019.
    [7]
    秦小锋, 赵宇辉. 大面积严重烧伤住院患者流行病学分析[J/CD].中华损伤与修复杂志(电子版),2021,16(5):417-426. DOI: 10.3877/cma.j.issn.1673-9450.2021.05.008.
    [8]
    ZhuZ, KongW, WangH, et al. Prevalence and predictors of scar contracture-associated re-hospitalisation among burn inpatients in China[J]. Sci Rep, 2021,11(1):14973. DOI: 10.1038/s41598-021-94432-w.
    [9]
    中华人民共和国卫生部. 医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320. DOI: 10.3760/j:issn:0376-2491.2001.05.027.
    [10]
    李惠春, 丁圣刚, 卜笑松, 等. 儿童患者耐甲氧西林金黄色葡萄球菌的流行病学特征及耐药性分析[J].安徽医科大学学报,2019,54(4):651-655. DOI: 10.19405/j.cnki.issn1000-1492.2019.04.030.
    [11]
    孙伟晶, 姚兴伟, 陈向军. 内蒙古地区1328例儿童烧伤流行病学调查[J].中华烧伤杂志,2012,28(3):229-230. DOI: 10.3760/cma.j.issn.1009-2587.2012.03.021.
    [12]
    朱光君, 张宏, 朱立强, 等. 山西北部地区儿童热液烫伤流行病学调查[J].中国病案,2013,14(6):50-52. DOI: 10.3969/j.issn.1672-2566.2013.06.026.
    [13]
    刘敏, 姚志慧, 白玉洁, 等. 2016-2018年某基层医院医院感染率调查[J].中华医院感染学杂志,2020,30(12):1899-1904. DOI: 10.11816/cn.ni.2020-191838.
    [14]
    RuanJ, XiM, XieW. Analysis of 12,661 pediatric burns in Wuhan institute of burns: a retrospective study of fifteen years[J]. Burns, 2021, 47(8):1915-1921. DOI: 10.1016/j.burns.2021.02.021.
    [15]
    ChenK, LiuJ, WangX, et al. Epidemiological characteristics of paediatric burn patients in China from 2016 to 2019: a retrospective study[J]. BMJ Paediatr Open, 2023, 7(1):e001796. DOI: 10.1136/bmjpo-2022-001796.
    [16]
    NakhaieS, SoboutiB, SalehiSH, et al. The role of serum albumin level during hospitalization as a predictor of complications and mortality in children with burns[J]. Med J Islam Repub Iran, 2023,37:41. DOI: 10.47176/mjiri.37.41.
    [17]
    YangY, ZhangX, ZhangJ, et al. Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study[J/OL]. Int J Surg, (2023-10-05)[2023-11-11]. https://pubmed.ncbi.nlm.nih.gov/37800568/.DOI: 10.1097/JS9.0000000000000808.[published online ahead of print].
    [18]
    SheridanRL, WeberJM. Mechanical and infectious complications of central venous cannulation in children: lessons learned from a 10-year experience placing more than 1000 catheters[J]. J Burn Care Res, 2006,27(5):713-718. DOI: 10.1097/01.BCR.0000238087.12064.E0.
    [19]
    GuanW, GongC, WuS, et al. Instant protection spray for anti-infection and accelerated healing of empyrosis[J]. Adv Mater, 2023:e2306589. DOI: 10.1002/adma.202306589.
    [20]
    CapoorMR, SarabahiS, TiwariVK, et al. Fungal infections in burns: diagnosis and management[J]. Indian J Plast Surg, 2010,43(Suppl):S37-42. DOI: 10.4103/0970-0358.70718.
    [21]
    中国老年医学学会烧创伤分会. 烧伤儿童心理康复治疗全国专家共识(2020版)[J].中华烧伤杂志,2020,36(11):987-992. DOI: 10.3760/cma.j.cn501120-20200623-00321.
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