新疆医科大学学报

目的 探讨冠状动脉旁路移植术后患者多重耐药菌(MDRO)感染的危险因素并构建列线图模型，以提高冠状动脉旁路移植术后患者MDRO感染防控的精准性。方法 回顾性分析2022年1月至2024年12月在新疆医科大学第一附属医院手术室接受冠状动脉旁路移植术的225例患者资料，按术后是否发生MDRO感染分为感染组(n=30)和未感染组(n=195)。采用单因素和多因素Logistic回归分析筛选术后MDRO感染的独立危险因素，借助R 4.3.0软件构建列线图模型，并利用受试者工作特征曲线(ROC)和Hosmer-Lemeshow检验评估模型的临床实用性。结果 单因素分析发现，感染组与未感染组在美国麻醉医师协会(ASA)评分≥3分、体外循环手术、重症监护病房住院时间> 3 d、术前营养(差)比较，差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，ASA评分≥3分、体外循环手术、重症监护病房住院时间>3 d及术前营养(差)为术后MDRO感染的独立危险因素(P均<0.05)。所构建的列线图模型ROC曲线下面积(Area under the curve,AUC)为0.854(95%CI:0.83～0.91),Hosmer-Lemeshow检验显示列线图模型区分度和拟合优度良好(χ²=8.435,P=0.039)。结论 本研究建立的冠状动脉旁路移植术后患者并发MDRO感染风险的列线图模型具有较强的预测效能，可为临床医务人员早期识别冠状动脉旁路移植术后MRDO感染风险并制定相应的防控措施提供参考。

Objective To explore the risk factors of multidrug-resistant organism(MDRO) infectionin patients aftercoronary artery bypass graftingand construct a nomogrammodel to improve the precision of postoperative infection prevention and control. Methods A retrospective analysis was conducted on the data of 225 patients who underwent coronary artery bypass grafting(CABG) in the operating room of the hospital from January 2022 to December 2024. The patients were divided into an infected group(n=30) and a non-infected group(n=195) based on the occurrence of postoperative MDRO infection. Univariate and multivariate Logistic regression analyses were used to screen for independent risk factors for postoperative MDRO infection. A nomogram model was constructed using R 4.4.3.0 software, and the clinical utility of the model was evaluated using receiver operating characteristic(ROC) curves and the Hosmer-Lemeshow test. Results Univariate analysis showed statistically significant differences between the infected and non-infected groups in American Society of Anesthesiologists(ASA) score ≥3, cardiopulmonary bypass(CPB) surgery, intensive care unit(ICU) length of stay >3 days, and preoperative nutritional status(poor)(P<0.05). Multivariate Logistic regressionanalysis revealed that ASA score ≥3, CPB surgery, ICU length of stay >3 days, and poor preoperative nutritional status were independent risk factors for postoperative MDRO infection(all P<0.05). The area under the curve(AUC) of the ROC curve for the constructed nomogram model was 0.854(95%CI:0.83～0.91). The Hosmer-Lemeshow test indicated good discrimination and calibration of the nomogram model(χ²=8.435, P=0.039). Conclusion The nomogram model established in this study for predicting the risk of MDRO infection in patients after CABG demonstrates strong predictive performance, providing a reference for clinical medical personnel to early identify the risk of MRDO infection after CABG and formulate corresponding prevention and control measures.