Etiology and utility of hospital-onset bacteremia as a safety metric for targeted harm reduction

Stack, Matthew A.; Dbeibo, Lana; Fadel, William F.; Kelley, Kristen; Sadowski, Joshua; Beeler, Cole

doi:10.1016/j.ajic.2023.06.002

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…In a recent singlecentre study in the USA, where device-associated bacteraemias, pneumonias, surgical complications and contaminated blood cultures were included in preventable HOB, 44% of 392 events were considered preventable. 12 Finally, the preventability rating tool used in our study was also adapted for use in the study of HOB in India, 13 where 45% of non-commensal HOB events were considered preventable, and infections associated with central lines, urinary catheter and mechanical ventilator accounted for 32% of preventable HOB events. Our findings on HOB preventability have implications for developing HOB as a potential quality metric.…”

Section: Discussionmentioning

confidence: 99%

“…17 Accounting for patients' intrinsic risk would also have lowered the perceived preventability of HOB events in our study, similar to a prior study in which estimates of preventability of hospital mortality decreased substantially when accounting for patients' likelihood of being alive in 3 months. 15 Second, when considering the use of HOB as a quality metric, 'enriching' the HOB measure by excluding non-preventable events, and risk adjusting to patient case mix, could help optimise allocation of quality improvement resources at the hospital level, improve buy-in with frontline clinicians 12 and reduce bias in interhospital comparisons. In our analyses, a positive blood culture prior to the index HOB event, regardless of whether the organism 'matched' the organism in the index HOB event, was associated with lower odds of preventability.…”

Section: Discussionmentioning

confidence: 99%

“…Second, when considering the use of HOB as a quality metric, ‘enriching’ the HOB measure by excluding non-preventable events, and risk adjusting to patient case mix, could help optimise allocation of quality improvement resources at the hospital level, improve buy-in with frontline clinicians 12 and reduce bias in interhospital comparisons. In our analyses, a positive blood culture prior to the index HOB event, regardless of whether the organism ‘matched’ the organism in the index HOB event, was associated with lower odds of preventability.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

Leekha,

Robinson,

Jacob

et al. 2024

BMJ Qual Saf

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BackgroundHospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability.MethodsWe conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non-commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1–3 were collectively considered ‘potentially preventable’ and 4–6 ‘potentially not preventable’.ResultsAmong 1789 HOB events with non-commensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non-commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non-commensal HOB events, events attributed to intravascular catheter-related infection, indwelling urinary catheter-related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and previous positive blood culture in the same admission had lower odds of being rated preventable, compared with events without those attributes. Of 636 potentially preventable non-commensal HOB events, 47% were endovascular in origin, followed by gastrointestinal, respiratory and urinary sources; approximately 40% of those events would not be captured through existing healthcare-associated infection surveillance.DiscussionFactors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB-related quality metric.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

Leekha,

Robinson,

Jacob

et al. 2024

BMJ Qual Saf

View full text Add to dashboard Cite

show abstract

“…23 This is worthy of attention given that the Centers for Medicare & Medicaid Services is currently reviewing an all-cause HOB metric. 24 As the definition for CAUTI has become more stringent, the prevalence of CAUTI has declined. 7,8,10 This study found that only 12.0% of all HOUTIs were identified as CAUTIs and thus the vast majority of HOUTIs did not meet currently reportable NHSN criteria.…”

Section: Discussionmentioning

confidence: 99%

Catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections: Relative burden, cost, outcomes and related hospital-onset bacteremia and fungemia infections

Kelly,

Ai,

Jung

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: To describe the relative burden of catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections (HOUTIs). Methods: A retrospective observational study of patients from 43 acute-care hospitals was conducted. CAUTI cases were defined as those reported to the National Healthcare Safety Network. Non-CAUTI HOUTI was defined as a positive, non-contaminated, non-commensal culture collected on day 3 or later. All HOUTIs were required to have a new antimicrobial prescribed within 2 days of the first positive urine culture. Outcomes included secondary hospital-onset bacteremia and fungemia (HOB), total hospital costs, length of stay (LOS), readmission risk, and mortality. Results: Of 549,433 admissions, 434 CAUTIs and 3,177 non-CAUTI HOUTIs were observed. The overall rate of HOB likely secondary to HOUTI was 3.7%. Total numbers of secondary HOB were higher in non-CAUTI HOUTIs compared to CAUTI (101 vs 34). HOB secondary to non-CAUTI HOUTI was more likely to originate outside the ICU compared to CAUTI (69.3% vs 44.1%). CAUTI was associated with adjusted incremental total hospital cost and LOS of $9,807 (P < .0001) and 3.01 days (P < .0001) while non-CAUTI HOUTI was associated with adjusted incremental total hospital cost and LOS of $6,874 (P < .0001) and 2.97 days (P < .0001). Conclusion: CAUTI and non-CAUTI HOUTI were associated with deleterious outcomes. Non-CAUTI HOUTI occurred more often and was associated with a higher facility aggregate volume of HOB than CAUTI. Patients at risk for UTIs in the hospital represent a vulnerable population who may benefit from surveillance and prevention efforts, particularly in the non-ICU setting.

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Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions

MacPhail,

Dendle,

Slavin

et al. 2024

Journal of Hospital Infection

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Etiology and utility of hospital-onset bacteremia as a safety metric for targeted harm reduction

Cited by 7 publications

References 16 publications

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study

Catheter-associated urinary tract infections (CAUTIs) and non-CAUTI hospital-onset urinary tract infections: Relative burden, cost, outcomes and related hospital-onset bacteremia and fungemia infections

Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions

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