Risk Prediction of Multidrug-Resistant Infections in Pediatric Burn Patients with Hospital-Acquired Infections: A Retrospective Cohort Study.

Abstract

Multidrug-resistant organism (MDRO) infections pose a growing threat to pediatric burn patients, contributing to prolonged hospitalization, increased healthcare burden, and limited therapeutic options. Despite their clinical significance, predictive tools specific to MDRO infections in this population remain scarce. To identify independent clinical predictors of MDRO infection among pediatric burn patients with healthcare-associated infections (HAIs) and to construct a validated nomogram for individualized risk estimation. A retrospective cohort study was conducted at a tertiary-care pediatric burn center in China, including patients aged 1 month to 18 years who developed HAIs between January 2020 and December 2023. Multivariable logistic regression was used to identify independent risk factors, and a nomogram was constructed accordingly. Model performance was evaluated using the area under the receiver operating characteristic (ROC) curve, calibration plot, decision curve analysis (DCA), and clinical impact curve. Among 763 pediatric burn patients with HAIs, 93 (12.2%) developed MDRO infections. Six independent predictors were identified: total burn surface area, length of hospital stay, ICU admission, mechanical ventilation, central venous catheter use, and acute inhalation injury. The nomogram demonstrated excellent discrimination (AUC = 0.962), good calibration, and favorable clinical utility across a range of threshold probabilities. This study presents a clinically applicable nomogram for early prediction of MDRO infection in pediatric burn patients with HAIs. The tool may support individualized risk stratification, guide targeted preventive interventions, and inform empirical antibiotic decision-making in burn care settings. Prospective validation is warranted.