Kritsotakis Evangelos I, Dimitriadis Ioannis, Roumbelaki Maria, Vounou Emelia, Kontou Maria, Papakyriakou Panikos, Koliou-Mazeri Maria, Varthalitis Ioannis, Vrouchos George, Troulakis George, Gikas Achilleas
Laboratory of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University of Crete, Greece.
Infect Control Hosp Epidemiol. 2008 Aug;29(8):685-92. doi: 10.1086/588704.
To examine the effect of heterogeneous case mix for a benchmarking analysis and interhospital comparison of the prevalence rates of nosocomial infection.
Cross-sectional survey.
Eleven hospitals located in Cyprus and in the region of Crete in Greece.
The survey included all inpatients in the medical, surgical, pediatric, and gynecology-obstetrics wards, as well as those in intensive care units. Centers for Disease Control and Prevention criteria were used to define nosocomial infection. The information collected for all patients included demographic characteristics, primary admission diagnosis, Karnofsky functional status index, Charlson comorbidity index, McCabe-Jackson severity of illness classification, use of antibiotics, and prior exposures to medical and surgical risk factors. Outcome data were also recorded for all patients. Case mix-adjusted rates were calculated by using a multivariate logistic regression model for nosocomial infection risk and an indirect standardization method.Results. The overall prevalence rate of nosocomial infection was 7.0% (95% confidence interval, 5.9%-8.3%) among 1,832 screened patients. Significant variation in nosocomial infection rates was observed across hospitals (range, 2.2%-9.6%). Logistic regression analysis indicated that the mean predicted risk of nosocomial infection across hospitals ranged from 3.7% to 10.3%, suggesting considerable variation in patient risk. Case mix-adjusted rates ranged from 2.6% to 12.4%, and the relative ranking of hospitals was affected by case-mix adjustment in 8 cases (72.8%). Nosocomial infection was significantly and independently associated with mortality (adjusted odds ratio, 3.6 [95% confidence interval, 2.1-6.1]).
The first attempt to rank the risk of nosocomial infection in these regions demonstrated the importance of accounting for heterogeneous case mix before attempting interhospital comparisons.
研究病例组合异质性对医院感染患病率基准分析及医院间比较的影响。
横断面调查。
位于塞浦路斯及希腊克里特岛地区的11家医院。
该调查涵盖了内科、外科、儿科以及妇产科病房的所有住院患者，还有重症监护病房的患者。采用美国疾病控制与预防中心的标准来定义医院感染。收集的所有患者信息包括人口统计学特征、初次入院诊断、卡氏功能状态指数、查尔森合并症指数、麦凯布 - 杰克逊疾病严重程度分类、抗生素使用情况以及既往接触医疗和手术风险因素的情况。还记录了所有患者的结局数据。通过使用医院感染风险的多变量逻辑回归模型和间接标准化方法计算病例组合调整率。结果。在1832例筛查患者中，医院感染的总体患病率为7.0%（95%置信区间，5.9% - 8.3%）。各医院间医院感染率存在显著差异（范围为2.2% - 9.6%）。逻辑回归分析表明，各医院医院感染的平均预测风险范围为3.7%至10.3%，提示患者风险存在相当大的差异。病例组合调整率范围为2.6%至12.4%，8例（72.8%）医院的相对排名受病例组合调整的影响。医院感染与死亡率显著且独立相关（调整优势比，3.6 [95%置信区间，2.1 - 6.1]）。
在这些地区首次尝试对医院感染风险进行排名表明，在进行医院间比较之前考虑病例组合异质性非常重要。
