{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:54:58Z","timestamp":1781848498695,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (KP) is a major pathogen in intensive care units and is associated with substantial mortality. However, prognostic tools specifically developed for intensive care unit (ICU) patients with KP infection remain limited. This study aimed to identify stable prognostic factors and develop a predictive model for mortality in this population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 587 adult ICU patients with culture-confirmed KP infection (first positive culture) at a tertiary hospital between August 2020 and February 2025 were retrospectively included. Candidate predictors were screened using least absolute shrinkage and selection operator (LASSO) and bootstrap-based stability selection to identify stable prognostic predictors. Using the final stable predictors, 11 models (including logistic regression and tree-based approaches) with 10-fold cross-validation were developed and compared. Model performance was evaluated using discrimination, calibration, and clinical utility. Generalized additive models (GAMs) were used to explore potential non-linear predictor\u2013outcome associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mortality occurred in 122\/587 patients (20.8%). Five stable prognostic factors were identified: Acute Physiology and Chronic Health Evaluation II (APACHE II) score, lactate, viral co-infection, acute kidney injury (AKI), and the alveolar\u2013arterial oxygen gradient (A-aDO\n                      <jats:sub>2<\/jats:sub>\n                      ). Among the evaluated algorithms, logistic regression achieved the most favorable balance of discrimination, calibration, and interpretability, with a cross-validated area under the receiver operating characteristic curve (AUC) of 0.809. Non-linear or threshold-like patterns were observed for APACHE II (approximately 16.56), lactate (approximately 2.87 mmol\/L), and the A-aDO\n                      <jats:sub>2<\/jats:sub>\n                      (approximately 203.27 mmHg). Based on logistic regression, a nomogram and a web-based calculator were constructed for individualized risk estimation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A parsimonious model based on five stable variables showed good performance for predicting mortality among ICU patients with KP infection. However, these findings are exploratory and require external validation before any clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1858732","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:48:37Z","timestamp":1781848117000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Machine learning-assisted prognostic model for mortality in ICU patients with culture-confirmed Klebsiella pneumoniae infection: a preliminary single-center retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xu","family":"Ran","sequence":"first","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaojun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Shao","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyue","family":"Ma","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinfu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Yang","sequence":"additional","affiliation":[{"name":"Medical Experimental Center, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Li","sequence":"additional","affiliation":[{"name":"Medical Experimental Center, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"597","DOI":"10.16718\/j.1009-7708.2025.06.002","article-title":"Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET Antimicrobial Resistance Surveillance Program, 2024","volume":"25","year":"2025","journal-title":"Chin. J. Infect. Chemother."},{"key":"B2","volume-title":"Antimicrobial susceptibility testing","author":"Bayot","year":"2026"},{"key":"B3","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12890-023-02394-8","article-title":"Clinical characteristics, risk factors and outcomes of Klebsiella pneumoniae pneumonia developing secondary Klebsiella pneumoniae bloodstream infection","volume":"23","author":"Chen","year":"2023","journal-title":"BMC Pulm. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/joim.13007","article-title":"Hypervirulent Klebsiella pneumoniae \u2013 clinical and molecular perspectives","volume":"287","author":"Choby","year":"2020","journal-title":"J. Intern. Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"7276","DOI":"10.1186\/s12879-023-08563-8","article-title":"Risk factors for carbapenem-resistant Klebsiella pneumoniae infection and associated clinical outcomes","volume":"13","author":"Dai","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/ijms27031229","article-title":"Molecular insights into carbapenem resistance in Klebsiella pneumoniae: From mobile genetic elements to precision diagnostics and infection control","volume":"27","author":"Elbehiry","year":"2026","journal-title":"Int. J. Mol. Sci."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/surgeries7020042","article-title":"Stratified procedural risk assessment in colorectal surgery: A comparative analysis of statistical and machine learning approaches using combined surgical approach and operative duration categories","volume":"7","author":"Elengickal","year":"2026","journal-title":"Surgeries"},{"key":"B8","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1186\/s13104-025-07325-w","article-title":"Predictive model for carbapenem-resistant Klebsiella pneumoniae bloodstream infection based on a nomogram: a retrospective study","volume":"18","author":"Guan","year":"2025","journal-title":"BMC Res. Notes"},{"key":"B9","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1186\/s12879-023-08563-8","article-title":"Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia","volume":"23","author":"Hafiz","year":"2023","journal-title":"BMC Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2025.1700934","article-title":"Clinical and genomic characterization of Klebsiella pneumoniae in a district hospital in Chengdu, China","volume":"16","author":"Hu","year":"2025","journal-title":"Front. Microbiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin. Pract."},{"key":"B13","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00003246-198510000-00009","article-title":"APACHE II: a severity of disease classification system","volume":"13","author":"Knaus","year":"1985","journal-title":"Crit. Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"357","DOI":"10.4274\/balkanmedj.galenos.2024.2024-5-99","article-title":"Resistance genes and mortality in carbapenem-resistant Klebsiella pneumoniae bacteremias: Effects of the COVID-19 pandemic","volume":"41","author":"Kurt","year":"2024","journal-title":"Balkan Med. J."},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000024835","article-title":"Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia","volume":"100","author":"Lee","year":"2021","journal-title":"Med. (Baltimore)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000033269","article-title":"Intensive care unit-acquired pneumonia caused by Klebsiella pneumoniae in China: Risk factors and prediction model of mortality","volume":"102","author":"Li","year":"2023","journal-title":"Medicine"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0324151","article-title":"The global burden of Klebsiella pneumoniae-associated lower respiratory infection in 204 countries and territories, 1990\u20132021: Findings from the global burden of disease study 2021","volume":"20","author":"Li","year":"2025","journal-title":"PLoS One"},{"key":"B18","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1186\/s12879-021-06325-y","article-title":"Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases","volume":"21","author":"Li","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"274","DOI":"10.21037\/atm.2020.02.63","article-title":"Clinical prediction models in the precision medicine era: old and new algorithms","volume":"8","author":"Luo","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1038\/s41598-025-85951-x","article-title":"Prediction of mortality risk in patients with severe community-acquired pneumonia in the intensive care unit using machine learning","volume":"15","author":"Pan","year":"2025","journal-title":"Sci. Rep."},{"key":"B22","unstructured":"Prognosis Prediction for Patients with Klebsiella pneumoniae Infection"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlae052","article-title":"Antimicrobial resistance of clinical bacterial isolates in China: current status and trends","volume":"6","author":"Qin","year":"2024","journal-title":"JAC-Antimicrob. Resist."},{"key":"B24","doi-asserted-by":"publisher","first-page":"3647","DOI":"10.2147\/IDR.S529532","article-title":"Clinical characterization, risk factors, and mortality in patients with carbapenem-resistant hypervirulent Klebsiella pneumoniae intra-abdominal infections","volume":"18","author":"Qiu","year":"2025","journal-title":"Infect. Drug Resist."},{"key":"B25","doi-asserted-by":"publisher","first-page":"4947","DOI":"10.1038\/s41598-022-09039-6","article-title":"A four specimen-pooling scheme reliably detects SARS-CoV-2 and influenza viruses using the BioFire FilmArray Respiratory Panel 2.1","volume":"12","author":"Ranadheera","year":"2022","journal-title":"Sci. Rep."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.3201\/eid2705.203662","article-title":"Characteristics and clinical implications of carbapenemase-producing Klebsiella pneumoniae colonization and infection, Italy","volume":"27","author":"Rossi","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/S1473-3099(25)00118-5","article-title":"The WHO Bacterial Priority Pathogens List 2024: a prioritisation study to guide research, development, and public health strategies against antimicrobial resistance","volume":"25","author":"Sati","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.01623-23","article-title":"Overview of changes in the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing: M100 32nd and 33rd editions","volume":"63","author":"Schuetz","year":"2025","journal-title":"J.\u00a0Clin. Microbiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"B30","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/S1473-3099(12)70205-0","article-title":"Klebsiella pneumoniae liver abscess: a new invasive syndrome","volume":"12","author":"Siu","year":"2012","journal-title":"Lancet Infect. Dis."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1186\/s12879-025-12120-w","article-title":"Global burden of Klebsiella pneumoniae infections and antimicrobial resistance in 2019","volume":"25","author":"Song","year":"2025","journal-title":"BMC Infect. Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1186\/s12879-025-12401-4","article-title":"Predictors of 30-day mortality in critically ill patients with bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: a five-year retrospective study","volume":"26","author":"Teo","year":"2025","journal-title":"BMC Infect. Dis."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.577244","article-title":"Clinical observation and prognostic analysis of patients with Klebsiella pneumoniae bloodstream infection","volume":"10","author":"Zhang","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1858732\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T05:48:39Z","timestamp":1781848119000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1858732\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":33,"alternative-id":["10.3389\/fcimb.2026.1858732"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1858732","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"article-number":"1858732"}}