Development of a risk prediction model for subsequent infection after colonization with carbapenem-resistant Enterobacterales: a retrospective cohort study.

BACKGROUND: Colonization of carbapenem-resistant Enterobacterale (CRE) is considered as one of vital preconditions for infection, with corresponding high morbidity and mortality. It is important to construct a reliable prediction model for those CRE carriers with high risk of infection. METHODS: A retrospective cohort study was conducted in two Chinese tertiary hospitals for patients with CRE colonization from 2011 to 2021. Univariable analysis and the Fine-Gray sub-distribution hazard model were utilized to identify potential predictors for CRE-colonized infection, while death was the competing event. A nomogram was established to predict 30-day and 60-day risk of CRE-colonized infection. RESULTS: 879 eligible patients were enrolled in our study and divided into training (n = 761) and validation (n = 118) group, respectively. There were 196 (25.8%) patients suffered from subsequent CRE infection. The median duration of subsequent infection after identification of CRE colonization was 20 (interquartile range [IQR], 14-32) days. Multisite colonization, polymicrobial colonization, catheterization and receiving albumin after colonization, concomitant respiratory diseases, receiving carbapenems and antimicrobial combination therapy before CRE colonization within 90 days were included in final model. Model discrimination and calibration were acceptable for predicting the probability of 60-day CRE-colonized infection in both training (area under the curve [AUC], 74.7) and validation dataset (AUC, 81.1). Decision-curve analysis revealed a significantly better net benefit in current model. Our prediction model is freely available online at https://ken-zheng.shinyapps.io/PredictingModelofCREcolonizedInfection/ . CONCLUSIONS: Our nomogram has a good predictive performance and could contribute to early identification of CRE carriers with a high-risk of subsequent infection, although external validation would be required.

Comparison of outcomes between minimally invasive oesophagectomy and open oesophagectomy for oesophageal cancer.

BACKGROUND: A systematic review with meta-analysis was performed to compare perioperative outcomes between minimally invasive oesophagectomy (MIE) and open oesophagectomy (OE). METHODS: PubMed and Cochrane databases were searched up to January 2015 using keywords: esophageal cancer, MIE, OE, hybrid MIE. Randomized controlled trials or prospective studies comparing the efficacy of OE with MIE or hybrid MIE in oesophageal cancer patients were included. Sensitivity analysis and quality assessment were performed. RESULTS: MIE required longer operation time (pooled standardized difference in means = 0.565; 95% confidence interval (CI) = 0.272, 0.858; P < 0.001) than OE, but resulted in less blood loss, shorter hospital stays, lower incidence of pneumonia and vocal cord palsy (P values ≤0.026). There was no difference between MIE and OE regarding lymph node yield (pooled standardized difference in means = 0.078; 95% CI = -0.111, 0.267; P = 0.419). Length of intensive care unit stay, in-hospital mortality and 30-day mortality were also similar (P values ≥0.419) in both groups. CONCLUSIONS: Regarding certain clinical outcomes, MIE may be more beneficial than OE.