Department of Epidemiology, Biostatistics and Occupational Health,McGill University,Montreal, Québec,Canada.
Direction des risques biologiques et de la santé au travail,Institut national de santé publique du Québec,Québec,Canada.
Infect Control Hosp Epidemiol. 2019 Mar;40(3):307-313. doi: 10.1017/ice.2018.357.
BACTOT, Quebec's healthcare-associated bloodstream infection (HABSI) surveillance program has been operating since 2007. In this study, we evaluated the changes in HABSI rates across 10 years of BACTOT surveillance under a Bayesian framework.
A retrospective, cohort study of eligible hospitals having participated in BACTOT for at least 3 years, regardless of their entry date. Multilevel Poisson regressions were fitted independently for cases of HABSI, catheter-associated bloodstream infections (CA-BSIs), non-catheter-associated primary BSIs (NCA-BSIs), and BSIs secondary to urinary tract infections (BSI-UTIs) as the outcome and log of patient days as the offset. The log of the mean Poisson rate was decomposed as the sum of a surveillance year effect, period effect, and hospital effect. The main estimate of interest was the cohort-level rate in years 2-10 of surveillance relative to year 1.
Overall, 17,479 cases and 33,029,870 patient days were recorded for the cohort of 77 hospitals. The pooled 10-year HABSI rate was 5.20 per 10,000 patient days (95% CI, 5.12-5.28). For HABSI, CA-BSI, and BSI-UTI, there was no difference between the estimated posterior rates of years 2-10 compared to year 1. The posterior means of the NCA-BSI rate ratios increased from the seventh year until the tenth year, when the rate was 29% (95% confidence interval, 1%-89%) higher than the first year rate.
HABSI rates and those of the most frequent subtypes remained stable over the surveillance period. To achieve reductions in incidence, we recommend that more effort be expended in active interventions against HABSI alongside surveillance.
魁北克的医疗保健相关血流感染（HABSI）监测项目 BACTOT 自 2007 年以来一直在运行。在这项研究中，我们在贝叶斯框架下评估了 BACTOT 监测 10 年来 HABSI 发生率的变化。
这是一项回顾性队列研究，纳入了至少参与 BACTOT 3 年的合格医院，无论其入组日期如何。使用多水平泊松回归模型，分别针对 HABSI、导管相关血流感染（CA-BSI）、非导管相关原发性血流感染（NCA-BSI）和尿路感染相关血流感染（BSI-UTI）病例进行拟合，将 HABSI 病例、CA-BSI、NCA-BSI 和 BSI-UTI 作为结局，将患者天数的对数作为偏移量。对数泊松率分解为监测年份效应、时期效应和医院效应之和。主要感兴趣的估计值是监测第 2-10 年与第 1 年相比的队列水平率。
共有 77 家医院的队列记录了 17479 例病例和 33029870 患者天。10 年总 HABSI 发生率为 5.20/10000 患者天（95%CI，5.12-5.28）。对于 HABSI、CA-BSI 和 BSI-UTI，第 2-10 年的估计后验率与第 1 年没有差异。NCA-BSI 率比的后验均值从第 7 年增加到第 10 年，第 10 年的比率比第 1 年高 29%（95%置信区间，1%-89%）。
在监测期间，HABSI 发生率和最常见的亚型发生率保持稳定。为了降低发病率，我们建议在进行 HABSI 监测的同时，投入更多精力进行针对 HABSI 的主动干预。
