Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Clin Infect Dis. 2021 Sep 15;73(6):1013-1019. doi: 10.1093/cid/ciab217.
US hospitals are required by the Centers for Medicare and Medicaid Services to publicly report central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioidesdiffficile, methicillin-resistant Staphylococcus aureus bacteremia, and selected surgical site infections for benchmarking and pay-for-performance programs. It is unclear, however, to what extent these conditions capture the full breadth of serious healthcare-associated infections (HAIs). The Centers for Disease Control and Prevention's (CDC's) hospital-onset Adult Sepsis Event (HO-ASE) definition could facilitate more comprehensive and efficient surveillance for serious HAIs, but the overlap between HO-ASE and currently reportable HAIs is unknown.
We retrospectively assessed the overlap between HO-ASEs and reportable HAIs among adults hospitalized between June 2015-June 2018 in 3 hospitals. Medical record reviews were conducted for 110 randomly selected HO-ASE cases to determine clinical correlates.
Among 282 441 hospitalized patients, 2301 (0.8%) met HO-ASE criteria and 1260 (0.4%) had reportable HAIs. In-hospital mortality rates were higher with HO-ASEs than reportable HAIs (28.6% vs 12.9%). Mortality rates for HO-ASE missed by reportable HAIs were substantially higher than mortality rates for reportable HAIs missed by HO-ASE (28.1% vs 6.3%). Reportable HAIs were only present in 334/2301 (14.5%) HO-ASEs, most commonly CLABSIs (6.0% of HO-ASEs), C. difficile (5.0%), and CAUTIs (3.0%). On medical record review, most HO-ASEs were caused by pneumonia (39.1%, of which only 34.9% were ventilator-associated), bloodstream infections (17.4%, of which only 10.5% were central line-associated), non-C. difficile intra-abdominal infections (14.5%), urinary infections (7.3%, of which 87.5% were catheter-associated), and skin/soft tissue infections (6.4%).
CDC's HO-ASE definition detects many serious nosocomial infections missed by currently reportable HAIs. HO-ASE surveillance could increase the efficiency and clinical significance of surveillance while identifying new targets for prevention.
美国医疗保险和医疗补助服务中心要求医院公开报告中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）、艰难梭菌、耐甲氧西林金黄色葡萄球菌菌血症以及某些手术部位感染，以进行基准测试和按绩效付费计划。然而，目前尚不清楚这些条件在多大程度上涵盖了所有严重的医院获得性感染（HAI）。疾病控制与预防中心（CDC）的医院获得性成人脓毒症事件（HO-ASE）定义可以促进对严重 HAI 进行更全面和有效的监测，但 HO-ASE 与目前报告的 HAI 之间的重叠情况尚不清楚。
我们回顾性评估了 2015 年 6 月至 2018 年 6 月期间在 3 家医院住院的成年人中 HO-ASE 和报告的 HAI 之间的重叠情况。对随机选择的 110 例 HO-ASE 病例进行病历回顾，以确定临床相关性。
在 282441 例住院患者中，有 2301 例（0.8%）符合 HO-ASE 标准，有 1260 例（0.4%）患有报告的 HAI。HO-ASE 患者的院内死亡率高于报告的 HAI（28.6% vs. 12.9%）。HO-ASE 漏报的死亡率明显高于报告的 HAI 漏报的死亡率（28.1% vs. 6.3%）。报告的 HAI 仅存在于 2301 例 HO-ASE 中的 334 例（14.5%）中，最常见的是 CLABSI（HO-ASE 的 6.0%）、艰难梭菌（5.0%）和 CAUTI（3.0%）。在病历回顾中，大多数 HO-ASE 是由肺炎引起的（39.1%，其中只有 34.9%是呼吸机相关性肺炎）、血流感染（17.4%，其中只有 10.5%是中心静脉导管相关的）、非艰难梭菌腹腔内感染（14.5%）、尿路感染（7.3%，其中 87.5%是导管相关的）和皮肤/软组织感染（6.4%）。
CDC 的 HO-ASE 定义检测到了目前报告的 HAI 漏报的许多严重医院获得性感染。HO-ASE 监测可以提高监测的效率和临床意义，同时确定新的预防目标。
