Journal article
Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study
BMJ quality & safety, Vol.33(8), pp.487-498
08/2024
DOI: 10.1136/bmjqs-2023-016831
PMCID: PMC11287649
PMID: 38782579
Abstract
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.
Details
- Title: Subtitle
- Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study
- Creators
- Surbhi Leekha - University of Maryland, BaltimoreGwen L Robinson - University of Maryland, BaltimoreJesse T Jacob - Emory UniversityScott Fridkin - Emory UniversityAndi Shane - Emory UniversityAnna Sick-Samuels - Johns Hopkins UniversityAaron M Milstone - Johns Hopkins UniversityRajeshwari Nair - University of IowaEli Perencevich - University of IowaMireia Puig-Asensio - Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USATakaaki Kobayashi - University of IowaJeanmarie Mayer - University of UtahJulia Lewis - University of UtahSusan Bleasdale - University of Illinois ChicagoEric Wenzler - University of Illinois ChicagoAlfredo J Mena Lora - University of Illinois ChicagoJonathan Baghdadi - University of Maryland, BaltimoreGregory M Schrank - University of Maryland, BaltimoreEli Wilber - Emory UniversityAmalia A Aldredge - Emory UniversityJoseph Sharp - Emory UniversityKelly E Dyer - Emory University School of MedicineLea Kendrick - Children's Healthcare of AtlantaViraj Ambalam - Johns Hopkins UniversityScott Borgetti - University of Illinois ChicagoAnna Carmack - University of Maryland, BaltimoreAlexis Gushiken - University of Maryland, BaltimoreAshka Patel - University of Maryland, BaltimoreSujan Reddy - Centers for Disease Control and PreventionClayton H Brown - University of Maryland, BaltimoreRaymund B Dantes - National Center for Emerging and Zoonotic Infectious DiseasesAnthony D Harris - University of Maryland, Baltimore
- Resource Type
- Journal article
- Publication Details
- BMJ quality & safety, Vol.33(8), pp.487-498
- DOI
- 10.1136/bmjqs-2023-016831
- PMID
- 38782579
- PMCID
- PMC11287649
- NLM abbreviation
- BMJ Qual Saf
- ISSN
- 2044-5415
- eISSN
- 2044-5423
- Publisher
- BMJ Publishing Group Ltd
- Grant note
- UL1TR002537 / Iowa Institute for Clinical and Translational Science 1U54CK000450-01 / CDC
- Language
- English
- Electronic publication date
- 05/23/2024
- Date published
- 08/2024
- Academic Unit
- Infectious Diseases; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984628237002771
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