Comparison of automated strategies for surveillance of nosocomial bacteremia.
- Bellini C Service de Médecine Préventive Hospitalière-CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland. cristina.bellini@chuv.ch
- Petignat C
- Francioli P
- Wenger A
- Bille J
- Klopotov A
- Vallet Y
- Patthey R
- Zanetti G
- 2007-10-13
Published in:
- Infection control and hospital epidemiology. - 2007
Algorithms
Bacteremia
Cohort Studies
Cross Infection
Humans
Sentinel Surveillance
Statistics as Topic
Switzerland
English
OBJECTIVE
Surveillance of nosocomial bloodstream infection (BSI) is recommended, but time-consuming. We explored strategies for automated surveillance.
METHODS
Cohort study. We prospectively processed microbiological and administrative patient data with computerized algorithms to identify contaminated blood cultures, community-acquired BSI, and hospital-acquired BSI and used algorithms to classify the latter on the basis of whether it was a catheter-associated infection. We compared the automatic classification with an assessment (71% prospective) of clinical data.
SETTING
An 850-bed university hospital.
PARTICIPANTS
All adult patients admitted to general surgery, internal medicine, a medical intensive care unit, or a surgical intensive care unit over 3 years.
RESULTS
The results of the automated surveillance were 95% concordant with those of classical surveillance based on the assessment of clinical data in distinguishing contamination, community-acquired BSI, and hospital-acquired BSI in a random sample of 100 cases of bacteremia. The two methods were 74% concordant in classifying 351 consecutive episodes of nosocomial BSI with respect to whether the BSI was catheter-associated. Prolonged episodes of BSI, mostly fungemia, that were counted multiple times and incorrect classification of BSI clinically imputable to catheter infection accounted for 81% of the misclassifications in automated surveillance. By counting episodes of fungemia only once per hospital stay and by considering all cases of coagulase-negative staphylococcal BSI to be catheter-related, we improved concordance with clinical assessment to 82%. With these adjustments, automated surveillance for detection of catheter-related BSI had a sensitivity of 78% and a specificity of 93%; for detection of other types of nosocomial BSI, the sensitivity was 98% and the specificity was 69%.
CONCLUSION
Automated strategies are convenient alternatives to manual surveillance of nosocomial BSI.
Surveillance of nosocomial bloodstream infection (BSI) is recommended, but time-consuming. We explored strategies for automated surveillance.
METHODS
Cohort study. We prospectively processed microbiological and administrative patient data with computerized algorithms to identify contaminated blood cultures, community-acquired BSI, and hospital-acquired BSI and used algorithms to classify the latter on the basis of whether it was a catheter-associated infection. We compared the automatic classification with an assessment (71% prospective) of clinical data.
SETTING
An 850-bed university hospital.
PARTICIPANTS
All adult patients admitted to general surgery, internal medicine, a medical intensive care unit, or a surgical intensive care unit over 3 years.
RESULTS
The results of the automated surveillance were 95% concordant with those of classical surveillance based on the assessment of clinical data in distinguishing contamination, community-acquired BSI, and hospital-acquired BSI in a random sample of 100 cases of bacteremia. The two methods were 74% concordant in classifying 351 consecutive episodes of nosocomial BSI with respect to whether the BSI was catheter-associated. Prolonged episodes of BSI, mostly fungemia, that were counted multiple times and incorrect classification of BSI clinically imputable to catheter infection accounted for 81% of the misclassifications in automated surveillance. By counting episodes of fungemia only once per hospital stay and by considering all cases of coagulase-negative staphylococcal BSI to be catheter-related, we improved concordance with clinical assessment to 82%. With these adjustments, automated surveillance for detection of catheter-related BSI had a sensitivity of 78% and a specificity of 93%; for detection of other types of nosocomial BSI, the sensitivity was 98% and the specificity was 69%.
CONCLUSION
Automated strategies are convenient alternatives to manual surveillance of nosocomial BSI.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1086/519861
- PMID 17932822
- Persistent URL
- https://sonar.ch/global/documents/125752
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