Abstract
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) infections can pose a significant risk following pediatric liver transplantations. This study aimed to identify risk factors for CRE infections and develop prediction models for pediatric recipients. METHODS: This study enrolled pediatric patients who underwent liver transplantation between 2017 and 2023. Risk factors for CRE infection were identified using logistic regression analysis. Prediction models were constructed using a training cohort and validated using internal and external validation cohorts. Predictive performance was assessed using receiver operating characteristic curves and area under the curve (AUC). RESULTS: CRE intestinal colonization before liver transplantation, bile or intestinal leakage and respiratory ribonucleic acid virus infections were independent risk factors for CRE infection after pediatric liver transplantation. Our prediction model comprising all three factors achieved AUC values of 0.724 and 0.738 in the training and internal validation cohorts, respectively. The AUC of an additional model constructed using CRE intestinal colonization and bile or intestinal leakage achieved 0.738 and 0.828 in the internal and external validation cohorts, respectively. Two nomograms were constructed. CONCLUSIONS: Both nomograms accurately predicted CRE infection after liver transplantation. They can facilitate the adoption of essential protective measures in pediatric liver transplant recipients.