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Comparison of Automated Strategies for Surveillance of Nosocomial Bacteremia

  • Cristina Bellini (a1), Christiane Petignat (a1), Patrick Francioli (a1), Aline Wenger (a2), Jacques Bille (a2), Adriana Klopotov (a3), Yannick Vallet (a3), René Patthey (a3) and Giorgio Zanetti (a1)...

Abstract

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.

Copyright

Corresponding author

Service de Médecine Préventive Hospitalière—CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland (cristina.bellini@chuv.ch)

References

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