Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study.

Autor:	Leekha S; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA sleekha@som.umaryland.edu., Robinson GL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Jacob JT; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Fridkin S; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Shane A; Department of Pediatrics, Emory University, Atlanta, Georgia, USA., Sick-Samuels A; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Milstone AM; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Nair R; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Perencevich E; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Puig-Asensio M; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Kobayashi T; Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Mayer J; Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA., Lewis J; Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA., Bleasdale S; Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA., Wenzler E; Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA., Mena Lora AJ; Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA., Baghdadi J; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Schrank GM; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Wilber E; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Aldredge AA; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Sharp J; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Dyer KE; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Kendrick L; Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Ambalam V; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Borgetti S; Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA., Carmack A; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Gushiken A; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Patel A; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Reddy S; Divison of Healthcare Quality Promotion, Nationation Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Brown CH; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA., Dantes RB; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Divison of Healthcare Quality Promotion, Nationation Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Harris AD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2024 Jul 22; Vol. 33 (8), pp. 487-498. Date of Electronic Publication: 2024 Jul 22.
DOI:	10.1136/bmjqs-2023-016831
Abstrakt:	Background: Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability. Methods: We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non-commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1-3 were collectively considered 'potentially preventable' and 4-6 'potentially not preventable'. Results: Among 1789 HOB events with non-commensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non-commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non-commensal HOB events, events attributed to intravascular catheter-related infection, indwelling urinary catheter-related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and previous positive blood culture in the same admission had lower odds of being rated preventable, compared with events without those attributes. Of 636 potentially preventable non-commensal HOB events, 47% were endovascular in origin, followed by gastrointestinal, respiratory and urinary sources; approximately 40% of those events would not be captured through existing healthcare-associated infection surveillance. Discussion: Factors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB-related quality metric. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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