尿道下裂术后患儿发生导尿管相关尿路感染的影响因素及列线图评估模型构建OA

Objective To analyze the influencing factors of catheter-associated urinary tract infection(CAUTI)in children after hypospadias surgery and construct a nomogram evaluation model.Methods A to-tal of 712 children who underwent hypospadias surgery in the hospital from May 2019 to June 2024 were se-lected as the research subjects.According to the ratio of 7∶3,they were randomly divided into the modeling set(498 cases)and the external validation set(214 cases).Then,the children in the modeling set were further divided into an infection group(120 cases)and a control group(378 cases)based on whether they developed CAUTI.Data of the children were collected.LASSO regression analysis was used to screen variables,and mul-tivariate Logistic regression was used to analyze the influencing factors of CAUTI in children after hypospadi-as surgery.The nomogram model for predicting CAUTI after hypospadias surgery was constructed,and the receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the discrimination and consistency of the nomogram model.Results There were significant differences in age,disease type,de-gree of penile curvature,length of urethral defect,use of prophylactic antibiotics,operation season,catheter in-dwelling time,cleaning frequency,preoperative hospital stay,postoperative pain degree,postoperative nutri-tional status and complications between the control group and the infection group,and the differences were statistically significant(P<0.05).A total of 6 potential variables related to CAUTI were screened out by LASSO regression analysis,including the use of prophylactic antibiotics,postoperative pain degree,catheter indwelling time,cleaning frequency,preoperative hospital stay and complications.Multivariate Logistic regres-sion analysis showed that no use of prophylactic antibiotics,moderate to severe postoperative pain,long cathe-ter indwelling time,low cleaning frequency,long preoperative hospital stay and complications were risk factors for CAUTI after hypospadias surgery in children(P<0.05).The calibration curve analysis results of internal validation showed that the model fit was good(Hosmer-Lemeshow χ2=6.063,P=0.640),the slope of the calibration curve was close to 1,and the consistency was good.The ROC curve analysis results of internal vali-dation showed that the area under the curve(AUC)of the nomogram model for predicting CAUTI in children after hypospadias surgery was 0.919,and the discrimination was good.The results of external validation showed that the model had good consistency(Hosmer-Lemeshow χ2=7.524,P=0.532)and discrimination(AUC=0.903).Conclusion The use of prophylactic antibiotics,postoperative pain degree,catheter indwell-ing time,cleaning frequency,preoperative hospital stay and complications are the influencing factors of CAUTI in children with hypospadias surgery.The nomogram model established in this study is highly practical.