Jessica P Ridgway1, Xiaowu Sun2, Ying P Tabak2, Richard S Johannes2, Ari Robicsek3. 1. Department of Medicine, University of Chicago, Chicago, IL. Electronic address: jessica.ridgway@uchospitals.edu. 2. CareFusion-BD, San Diego, CA. 3. Department of Medicine, NorthShore University HealthSystem, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL; Department of Health Information Technology, NorthShore University HealthSystem, Evanston, IL.
Abstract
BACKGROUND: The objective of this study was to evaluate performance metrics and associated patient outcomes of an automated surveillance system, the blood Nosocomial Infection Marker (NIM). METHODS: We reviewed records of 237 patients with and 36,927 patients without blood NIM using the National Healthcare Safety Network (NHSN) definition for laboratory-confirmed bloodstream infection (BSI) as the gold standard. We matched cases with noncases by propensity score and estimated attributable mortality and cost of NHSN-reportable central line-associated bloodstream infections (CLABSIs) and non-NHSN-reportable BSIs. RESULTS: For patients with central lines (CL), the blood NIM had 73.2% positive predictive value (PPV), 99.9% negative predictive value (NPV), 89.2% sensitivity, and 99.7% specificity. For all patients regardless of CL status, the blood NIM had 53.6% PPV, 99.9% NPV, 84.0% sensitivity, and 99.9% specificity. For CLABSI cases compared with noncases, mortality was 17.5% versus 9.4% (P = .098), and median charge was $143,935 (interquartile range [IQR], $89,794-$257,447) versus $115,267 (IQR, $74,937-$173,053) (P < .01). For non-NHSN-reportable BSI cases compared with noncases, mortality was 23.6% versus 6.7% (P < .0001), and median charge was $86,927 (IQR, $54,728-$156,669) versus $62,929 (IQR, $36,743-$115,693) (P < .0001). CONCLUSIONS: The NIM is an effective screening tool for BSI. Both NHSN-reportable and nonreportable BSI cases were associated with increased mortality and cost.
BACKGROUND: The objective of this study was to evaluate performance metrics and associated patient outcomes of an automated surveillance system, the blood Nosocomial Infection Marker (NIM). METHODS: We reviewed records of 237 patients with and 36,927 patients without blood NIM using the National Healthcare Safety Network (NHSN) definition for laboratory-confirmed bloodstream infection (BSI) as the gold standard. We matched cases with noncases by propensity score and estimated attributable mortality and cost of NHSN-reportable central line-associated bloodstream infections (CLABSIs) and non-NHSN-reportable BSIs. RESULTS: For patients with central lines (CL), the blood NIM had 73.2% positive predictive value (PPV), 99.9% negative predictive value (NPV), 89.2% sensitivity, and 99.7% specificity. For all patients regardless of CL status, the blood NIM had 53.6% PPV, 99.9% NPV, 84.0% sensitivity, and 99.9% specificity. For CLABSI cases compared with noncases, mortality was 17.5% versus 9.4% (P = .098), and median charge was $143,935 (interquartile range [IQR], $89,794-$257,447) versus $115,267 (IQR, $74,937-$173,053) (P < .01). For non-NHSN-reportable BSI cases compared with noncases, mortality was 23.6% versus 6.7% (P < .0001), and median charge was $86,927 (IQR, $54,728-$156,669) versus $62,929 (IQR, $36,743-$115,693) (P < .0001). CONCLUSIONS: The NIM is an effective screening tool for BSI. Both NHSN-reportable and nonreportable BSI cases were associated with increased mortality and cost.
Authors: Laura Puzniak; Daryl D DePestel; Arjun Srinivasan; Gang Ye; John Murray; Sanjay Merchant; C Andrew DeRyke; Vikas Gupta Journal: Antimicrob Agents Chemother Date: 2019-03-27 Impact factor: 5.191
Authors: Eilish McCann; Arjun Srinivasan; C Andrew DeRyke; Gang Ye; Daryl D DePestel; John Murray; Vikas Gupta Journal: Open Forum Infect Dis Date: 2018-09-21 Impact factor: 3.835