AUTHOR=He Yajun , Xu Jiqian , Shang Xiaopu , Fang Xiangzhi , Gao Chenggang , Sun Deyi , Yao Lu , Zhou Ting , Pan Shangwen , Zou Xiaojing , Shu Huaqing , Yang Xiaobo , Shang You 

TITLE=Clinical characteristics and risk factors associated with ICU-acquired infections in sepsis: A retrospective cohort study

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.962470

DOI=10.3389/fcimb.2022.962470

ISSN=2235-2988

ABSTRACT=Intensive care unit (ICU)-acquired infection is a common cause of poor prognosis of sepsis in ICU. However, sepsis-associated ICU-acquired infections have not been fully characterized. The study aims to assess the risk factors and develop a model that predict the risk of ICU-acquired infections in patients with sepsis. Methods: We retrieved data from the Medical Information Mart for Intensive Care (MIMIC) IV database.  Patients were randomly divided into training and validation cohorts at a 7:3 ratio. A multivariable logistic regression model was used to identify independent risk factors that could predict ICU-acquired infection. And we assessed its discrimination and calibration abilities, and compare them with classical score systems.  Results: Of 16808 included septic patients, 2871(17.1%) developed ICU-acquired infection, these patients with ICU-acquired infection had a 17.7% ICU mortality and 31.8% in-hospital mortality, and showed a continued rise in mortality from 28 to 100 days after ICU admission.  The classical SIRS,SOFA,OASIS,SAPS II,LODS,CCI,and APS III scores were associated with ICU-acquired infection, and the cerebrovascular insufficiency, gram-negative bacteria, surgical ICU, tracheostomy, central venous catheter, urinary catheter, mechanical ventilation, RBC transfusion, and anticoagulant therapy were independent predictors of developing ICU-acquired infection in septic patients. The nomogram on the basis of these independent predictors showed good calibration and discrimination in both the derivation (AUROC 0.737, 95% CI 0.725-0.749) and validation (AUROC 0.751, 95% CI 0.734-0.769) populations, and was superior to that of SIRS,SOFA,OASIS,SAPS II,LODS,CCI,and APS III models. Conclusions: ICU-acquired infections increase the likelihood of septic mortality. The individualized prognostic model on the basis of the  nomogram could accurately predict ICU-acquired infection and optimize management or tailored therapy.