Purpose: This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE)
acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance.
Methods: This unmatched case-control study included 352 adult patients (55 patients and 297 controls)
admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1,
2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk
factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-thelarge,
the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity
of the training set, subsets, and a new test set.
Results: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were
Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous
catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE
acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1,
c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good
in the subsets and new test set.
Conclusion: The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a
similar case mix to patients in the study hospitals. Future studies need to involve more rigorous
methodology and larger samples.