Hospital-onset bacteremia and fungemia: An evaluation of predictors and feasibility of benchmarking comparing two risk-adjusted models among 267 hospitals

Abstract

Objectives: To evaluate the prevalence of hospital-onset bacteremia and fungemia (HOB), identify hospital-level predictors, and to evaluate the feasibility of an HOB metric. Methods: We analyzed 9,202,650 admissions from 267 hospitals during 2015–2020. An HOB event was defined as the first positive blood-culture pathogen on day 3 of admission or later. We used the generalized linear model method via negative binomial regression to identify variables and risk markers for HOB. Standardized infection ratios (SIRs) were calculated based on 2 risk-adjusted models: a simple model using descriptive variables and a complex model using descriptive variables plus additional measures of blood-culture testing practices. Performance of each model was compared against the unadjusted rate of HOB. Results: Overall median rate of HOB per 100 admissions was 0.124 (interquartile range, 0.00–0.22). Facility-level predictors included bed size, sex, ICU admissions, community-onset (CO) blood culture testing intensity, and hospital-onset (HO) testing intensity, and prevalence (all P < .001). In the complex model, CO bacteremia prevalence, HO testing intensity, and HO testing prevalence were the predictors most associated with HOB. The complex model demonstrated better model performance; 55% of hospitals that ranked in the highest quartile based on their raw rate shifted to a lower quartile when the SIR from the complex model was applied. Conclusions: Hospital descriptors, aggregate patient characteristics, community bacteremia and/or fungemia burden, and clinical blood-culture testing practices influence rates of HOB. Benchmarking an HOB metric is feasible and should endeavor to include both facility and clinical variables.

Characteristics, costs, and outcomes associated with central-line–associated bloodstream infection and hospital-onset bacteremia and fungemia in US hospitals

“…In this multicenter database encompassing almost 800,000 hospitalized adult patients, there were ∼4 times as many non-CLABSI HOB cases as CLABSI cases (1,574 vs 403) using a conservative EHR-based case definition that only included the first positive blood culture with a CDC-designated BSI pathogen. 8 Compared with matched controls, both CLABSIs and non-CLABSI HOB cases were associated with increases in LOS and significantly higher hospital costs, mortality rates, and 30-day readmission rates. Rock et al 4 reported that among ICU patients, changes in HOB rates are highly associated with changes in CLABSI rates.…”

“…CoNS were excluded from eligible pathogens for non-CLABSI HOB. 8 For patients who had positive urine cultures with the same microorganism as the HOB, Enterobacteriaceae was the most common microorganism (61% of positive urine cultures in all HOB admissions). S. aureus was the most common shared microorganism present in respiratory (42%) and skin/soft tissue (53%) cultures (Supplementary Table S5).…”

“…We conducted a retrospective observational study of patients in 41 acute-care hospitals in the BD Insights Research and Database (Becton, Dickinson and Company, Franklin Lakes, NJ), which contains electronically captured data encompassing pharmacy, laboratory, administrative data, patient demographics, and admission, discharge, and transfer data feeds. 8,[10][11][12] The distribution of hospitals in this database is similar to the hospital distribution in the United States as a whole. 12 Included patients were aged ≥18 years and had been admitted between October 2015 and June 2019.…”

“…7 In addition to providing a more inclusive measure of hospital BSI sources, an HOB metric could be standardized and risk-adjusted using the electronic health record (EHR), thereby eliminating the subjectivity associated with central-line attributions. 8…”

Prevalence of Hospital-Onset Bacteremia Pre- and Post-Implementation of a Needleless Blood Sampling Device From Existing Peripheral Catheters

“…[1][2][3][4] Central line-associated bloodstream infections (CLABSIs) are a mandated quality metric, but bloodstream infections from other sources also result in significant morbidity and cost. 1,5 Hospital-onset bacteremia and fungemia (HOB) has been suggested as a more comprehensive quality metric, [6][7][8][9] and at the time of this writing, has currently passed the National Quality Forum (NQF) Patient Safety Committee review as a recommended metric to the Centers for Medicare & Medicaid Services (CMS). 10 Peripheral intravenous (IV) devices are documented sources of bacteremia.…”