Gastmeier P, Geffers C, Daschner F, Rüden H
Institut für Hygiene, Freien Universität Berlin.
Zentralbl Hyg Umweltmed. 1998 Jun;201(2):153-66.
The data of surveillance of nosocomial infections are used as clinical indicators of quality. Their diagnosis must therefore be accurate. One hundred medical records from surgical and intensive care patients were used to assess the accuracy of diagnosing nosocomial infections according to CDC definitions. All case histories included signs and symptoms of infection. There were 45 patients with a total of 60 nosocomial infections (18 urinary tract infections, 18 surgical site infections, 11 lower respiratory tract infections and 13 other infection types). After evaluating the medical records, 18 physicians independently decided whether or not there was a nosocomial infection and, if so, the type of underlying infection. Their results were compared to the diagnosis of two experienced physicians (gold standard). Twenty-five cases were assessed on each of four consecutive days and the results were discussed with the experienced physicians on the following morning. The discussions of the first day may thus have been influenced by the results of the following days. Overall sensitivity was 85.4% (Cl95 82.8-87.8%) and overall specificity was 97.1% (Cl95 95.8-98.0%). Among the most common types of nosocomial infections, urinary tract infections had the highest sensitivity (90.1%), followed by surgical site infections (87.3%) and lower respiratory tract infections (85.8%). The specificity for these types of infections was 98.2%, 98.9% and 99.5%, respectively. Although the method of investigation used does not fulfill the formal requirements of a validation study for diagnosing nosocomial infections, it seems useful for training in the diagnostics of nosocomial infections or for intermittent evaluation of criteria before starting surveillance activities. This method is useful for training the application of CDC definitions, particularly when the medical records are reduced to case studies that include only the basic information on determining the presence of a nosocomial infection in order to evaluate a large number of suspected cases in a short period of time.
医院感染监测数据用作质量的临床指标。因此，其诊断必须准确。选取了100份外科和重症监护患者的病历，以根据美国疾病控制与预防中心（CDC）的定义评估医院感染诊断的准确性。所有病历均包含感染的体征和症状。有45例患者，共发生60例医院感染（18例尿路感染、18例手术部位感染、11例下呼吸道感染和13例其他感染类型）。在评估病历后，18位医生独立判定是否存在医院感染，若存在，则判定潜在感染的类型。将他们的结果与两位经验丰富的医生的诊断结果（金标准）进行比较。连续四天每天评估25个病例，并于次日上午与经验丰富的医生讨论结果。因此，第一天的讨论可能受到后续几天结果的影响。总体敏感性为85.4%（95%置信区间82.8 - 87.8%），总体特异性为97.1%（95%置信区间95.8 - 98.0%）。在最常见的医院感染类型中，尿路感染的敏感性最高（90.1%），其次是手术部位感染（87.3%）和下呼吸道感染（85.8%）。这些感染类型的特异性分别为98.2%、98.9%和99.5%。尽管所采用的调查方法未满足医院感染诊断验证研究的正式要求，但它似乎有助于医院感染诊断的培训，或在开始监测活动前对标准进行间歇性评估。该方法有助于培训CDC定义的应用，特别是当病历简化为仅包含确定医院感染存在的基本信息的案例研究时，以便在短时间内评估大量疑似病例。
