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External Validation of Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Model in a Medium Sized Hospital
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Su Min Seo, Ihn Sook Jeong
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J Korean Acad Nurs 2020;50(4):621-630. Published online August 31, 2020
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DOI: https://doi.org/10.4040/jkan.20137
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 Abstract
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- Purpose
This study was aimed to evaluate the external validity of a carbapenem-resistant Enterobacteriaceae (CRE) acquisition risk prediction model (the CREP-model) in a medium-sized hospital.
Methods
This retrospective cohort study included 613 patients (CRE group: 69, no-CRE group: 544) admitted to the intensive care units of a 453-beds secondary referral general hospital from March 1, 2017 to September 30, 2019 in South Korea. The performance of the CREP-model was analyzed with calibration, discrimination, and clinical usefulness.
Results
The results showed that those higher in age had lower presence of multidrug resistant organisms (MDROs), cephalosporin use ≥ 15 days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 21 points, and lower CRE acquisition rates than those of CREP-model development subjects. The calibration-in-the-large was 0.12 (95% CI: - 0.16~0.39), while the calibration slope was 0.87 (95% CI: 0.63~1.12), and the concordance statistic was .71 (95% CI: .63~.78). At the predicted risk of .10, the sensitivity, specificity, and correct classification rates were 43.5%, 84.2%, and 79.6%, respectively. The net true positive according to the CREP-model were 3 per 100 subjects. After adjusting the predictors’ cutting points, the concordance statistic increased to .84 (95% CI: .79~.89), and the sensitivity and net true positive was improved to 75.4%. and 6 per 100 subjects, respectively.
Conclusion
The CREP-model’s discrimination and clinical usefulness are low in a medium sized general hospital but are improved after adjusting for the predictors. Therefore, we suggest that institutions should only use the CREP-model after assessing the distribution of the predictors and adjusting their cutting points.
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Citations
Citations to this article as recorded by  - Risk factors for the colonization of carbapenem-resistant Enterobacteriaceae in patients transferred to a small/medium-size hospital in Korea: a retrospective study
Misun Lee, Hyunjung Kim
Journal of Korean Biological Nursing Science.2023; 25(4): 285. CrossRef - Improving the Rapidity and Accuracy of Carbapenem-Resistant Enterobacteriaceae Detection by Shortening the Enrichment Duration
Miyoung Lee
Microbiology and Biotechnology Letters.2022; 50(4): 584. CrossRef - Validation Study of the Estimated Glycemic Load Model Using Commercially Available Fast Foods
Miran Lee, Haejin Kang, Sang-Jin Chung, Kisun Nam, Yoo Kyoung Park
Frontiers in Nutrition.2022;[Epub] CrossRef - Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital
Su Min Seo, Ihn Sook Jeong, Ju Yeoun Song, Sangjin Lee
Asian Nursing Research.2021; 15(3): 174. CrossRef
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