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Objective To explore the influencing factors of Escherichia coli (E. coli) colonization in the production of extended spectrum β-lactamase (ESBL) in elderly hospitalized patients and establish a prediction model. Methods A total of 140 elderly patients admitted to Changzhi People's Hospital from August 2022 to November 2023 were selected and divided into the modeling cohort, and another 63 elderly patients admitted to our hospital during the same period were selected as the validation cohort. Patients with ESBL-producing E. coli colonization detected in the modeling cohort were divided into the exposed group, and patients without ESBL-producing E. coli colonization were divided into the non-exposed group. Baseline data, antibacterial drug use, and comorbidities were collected from the two groups. Multivariate logistic regression analysis was performed for the indicators with differences. Multivariate logistic regression analysis results were used to construct a nomogram model. Column identification was assessed by C-index, and ROC curve was used to assess the internal validation results. Receiver operating characteristic curve (ROC curve) was drawn to evaluate the value of the prediction model and construct a calibration curve and decision curve were constructed. Results There were no significant differences in baseline data between the modeling cohort and the validation cohort (P > 0.05) . In the modeling cohort, 35 patients with ESBL-producing E. coli colonization detected were in the exposed group and 105 patients without ESBL-producing E. coli colonization were in the non-exposed group, and there were significant differences in the use of third-generation cephalosporins, urinary catheter indwelling, gastric tube indwelling, combined antibiotics, and length of hospital stay between the two groups (P < 0.05) . The results of multivariate logistic regression analysis showed that the use of third-generation cephalosporins, urinary catheter indwelling, gastric tube indwelling, combined antibiotics and length of hospital stay were independent risk factors affecting ESBL-producing E. coli colonization (P < 0.05) . The constructed prediction models were internally validated with the validation cohort, and the results showed that the models showed high discrimination and calibration in both the modeling cohort and the validation cohort, and the Hosmer Lemeshow test showed that there were no significant differences between the predicted probabilities and the actual probabilities in the validation cohort and the modeling cohort (P > 0.05) . The nomogram prediction model developed from the results of multivariate logistic regression analysis, validated by the validated cohort, showed an AUC of 0.917 (95% CI: 0.861 - 0.973) by ROC curve, indicating a high accuracy of the prediction model. Conclusion The use of third-generation cephalosporins, length of hospital stay, urinary catheter indwelling, gastric tube indwelling and combined antibiotics are all important influencing factors of ESBL-producing E. coli colonization in patients, and the nomogram model constructed based on this has high clinical value. |
