Infection Prevention and Control, Alberta Health Services, AB, Canada.
Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Medicine, University of Calgary, Calgary, AB, Canada; Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada.
Am J Infect Control. 2020 Dec;48(12):1431-1436. doi: 10.1016/j.ajic.2020.08.016. Epub 2020 Aug 15.
Clostridioides difficile infection (CDI) is one of the most common health care-associated infections. This study assessed the validity of the Discharge Abstract Database (DAD) compared to a traditional clinical surveillance method for identifying CDI.
Retrospective analysis of all DAD records with International Statistical Classification of Diseases and Related Health Problems 10th Revision (ie, ICD-10) diagnostic code A04.7 (enterocolitis due to CDI) between April 2015 and March 2019 were compared to a clinical dataset of positive inpatient CDI for all acute care facilities in Alberta, Canada. Sensitivity and positive predictive values were calculated using R version 3.6.0.
The DAD had a sensitivity of 85.0% (95% confidence interval: 84.1%-85.8%) and a positive predictive value of 80.0% (95% confidence interval: 79.2%-80.0%). The CDI rate per 1,000 admissions over the study period was 28% higher in the DAD compared to Infection Prevention and Control surveillance.
The DAD does not distinguish symptomatic cases from asymptomatic cases and so indicators to identify symptomatic disease would need to be applied, potentially through a linkage to antibiotic treatment orders available in patient management systems.
The DAD is moderately sensitive for identifying symptomatic CDI cases in Alberta, Canada and caution should be applied when interpreting rates based on administrative data.
艰难梭菌感染（CDI）是最常见的医疗保健相关感染之一。本研究评估了与传统临床监测方法相比，出院摘要数据库（DAD）用于识别 CDI 的有效性。
对 2015 年 4 月至 2019 年 3 月期间所有 DAD 记录（国际疾病分类和相关健康问题第十次修订版（即 ICD-10）诊断代码 A04.7（艰难梭菌引起的肠炎））与加拿大艾伯塔省所有急性护理设施的阳性住院 CDI 临床数据集进行回顾性分析。使用 R 版本 3.6.0 计算敏感性和阳性预测值。
DAD 的敏感性为 85.0%（95%置信区间：84.1%-85.8%），阳性预测值为 80.0%（95%置信区间：79.2%-80.0%）。与感染预防和控制监测相比，在研究期间，DAD 中每 1000 例入院的 CDI 发生率高 28%。
DAD 无法区分有症状病例和无症状病例，因此需要应用识别有症状疾病的指标，可能通过与患者管理系统中可用的抗生素治疗医嘱建立联系。
DAD 对识别加拿大艾伯塔省的有症状 CDI 病例具有中等敏感性，在解释基于行政数据的发生率时应谨慎。
