Concordance between European and US case definitions of healthcare-associated infections

Antimicrobial Resistance and Infection Control

Sonja Hansen¹  Dorit Sohr¹  Christine Geffers¹  Pascal Astagneau²  Alexander Blacky³  Walter Koller³  Ingrid Morales⁴  Maria Luisa Moro⁶  Mercedes Palomar⁸  Emese Szilagyi⁷  Carl Suetens⁵  Petra Gastmeier¹ 

[1] Institute for Hygiene and Environmental Medicine, Charité – University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 27, D-12203, Berlin, Germany

[2] C-CLIN Nord - Département de santé publique, Université Pierre & Marie Curie, Paris, France

[3] Clinical Institute for Hygiene and Medical Microbiology, Medical University of Vienna, Vienna, Austria

[4] National Surveillance of Infections in Hospitals - NSIH, Operational Direction Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium

[5] European Centre for Disease Prevention and Control, Stockholm, Sweden

[6] Agenzia Sanitaria e Sociale Regione Emilia Romagna, Area di Programma Rischio Infettivo, Bologna, Italy

[7] National Centre for Epidemiology, Department of Hospital Epidemiology, Budapest, Hungary

[8] Department of Intensive Care, Hospital Vall d'Hebron, Barcelona, Spain

关键词: Healthcare-associated infections;    Definitions;    Pneumonia;    Bloodstream infection;   

Others  :  791138
DOI  :  10.1186/2047-2994-1-28

 received in 2012-03-18, accepted in 2012-07-17,  发布年份 2012

【 摘 要 】

Background

Surveillance of healthcare-associated infections (HAI) is a valuable measure to decrease infection rates. Across Europe, inter-country comparisons of HAI rates seem limited because some countries use US definitions from the US Centers for Disease Control and Prevention (CDC/NHSN) while other countries use European definitions from the Hospitals in Europe Link for Infection Control through Surveillance (HELICS/IPSE) project. In this study, we analyzed the concordance between US and European definitions of HAI.

Methods

An international working group of experts from seven European countries was set up to identify differences between US and European definitions and then conduct surveillance using both sets of definitions during a three-month period (March 1^st -May 31^st, 2010). Concordance between case definitions was estimated with Cohen’s kappa statistic (κ).

Results

Differences in HAI definitions were found for bloodstream infection (BSI), pneumonia (PN), urinary tract infection (UTI) and the two key terms “intensive care unit (ICU)-acquired infection” and “mechanical ventilation”. Concordance was analyzed for these definitions and key terms with the exception of UTI. Surveillance was performed in 47 ICUs and 6,506 patients were assessed. One hundred and eighty PN and 123 BSI cases were identified. When all PN cases were considered, concordance for PN was κ = 0.99 [CI 95%: 0.98-1.00]. When PN cases were divided into subgroups, concordance was κ = 0.90 (CI 95%: 0.86-0.94) for clinically defined PN and κ = 0.72 (CI 95%: 0.63-0.82) for microbiologically defined PN. Concordance for BSI was κ = 0.73 [CI 95%: 0.66-0.80]. However, BSI cases secondary to another infection site (42% of all BSI cases) are excluded when using US definitions and concordance for BSI was κ = 1.00 when only primary BSI cases, i.e. Europe-defined BSI with ”catheter” or “unknown” origin and US-defined laboratory-confirmed BSI (LCBI), were considered.

Conclusions

Our study showed an excellent concordance between US and European definitions of PN and primary BSI. PN and primary BSI rates of countries using either US or European definitions can be compared if the points highlighted in this study are taken into account.

【 授权许可】

   
2012 Hansen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, Hooton TM: The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985, 121:182-205.
• [2]Geubbels E, Bakker HG, Houtman P, Van Noort-Klaassen MA, Pelk MS, Sassen TM, Wille JC: Promoting quality through surveillance of surgical site infections: five prevention success stories. Am J Infect Control 2004, 32:424-430.
• [3]Gastmeier P, Schwab F, Sohr D, Behnke M, Geffers C: Reproducibility of the surveillance effect to decrease nosocomial infection rates. Infect Control Hosp Epidemiol 2009, 30:993-999.
• [4]Astagneau P, L'Hériteau F: Surveillance of surgical-site infections: impact on quality of care and reporting dilemmas. Curr Opin Infect Dis 2010, 23:306-310.
• [5]Gastmeier P, Sohr D, Schwab F, Behnke M, Zuschneid I, Brandt C, Dettenkofer M, Chaberny IF, Rüden H, Geffers C: Ten years of KISS: the most important requirements for success. J Hosp Infect 2008, 70(Suppl 1):11-16.
• [6]Gaynes R, Richards C, Edwards J, Emori TG, Horan T, Alonso-Echanove J, Fridkin S, Lawton R, Peavy G, Tolson J: Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001, 7:295-298.
• [7]Horan TC, White JW, Jarvis WR, Emori TG, Culver DH, Munn VP, Thornsberry C, Olson DR, Hughes JM: Nosocomial infection surveillance, 1984. MMWR CDC Surveill Summ 1986, 35:17-29.
• [8]Hughes JM: Nosocomial infection surveillance in the United States: historical perspective. Infect Control 1987, 8:450-453.
• [9]Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988, 16:128-140.
• [10]Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992, 13:606-608.
• [11]Horan T, Gaynes R: Surveillance of nosocomial infections. In Hospital Epidemiology and Infection Control. 3rd edition. Edited by Mayhall CG. Philadelphia: Lippincott Williams &Wilkins; 2004:1659-1689.
• [12]Horan TC, Andrus M, Dudeck MA: CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008, 36:309-332.
• [13]Gould C, Allen-Bridson K, Horan T: Surveillance definitions for urinary tract infections. Clin Infect Dis 2009, 49:1288-1289.
• [14]Horan TC, Emori TG: Definitions of key terms used in the NNIS System. Am J Infect Control 1997, 25:112-116.
• [15]Gastmeier P, Kampf G, Wischnewski N, Schumacher M, Daschner F, Rüden H: Importance of the surveillance method: national prevalence studies on nosocomial infections and the limits of comparison. Infect Control Hosp Epidemiol 1998, 19:661-667.
• [16]Decision No 2119/98/EC of the European Parliament and of the Council of 24 September 1998 setting up a network for the epidemiological surveillance and control of communicable diseases in the Community. http://ec.europa.eu/health/communicable_diseases/early_warning/comm_legislation_en.htm webcite (accessed on 2012-03-12)
• [17]Suetens C, Savey A, Labeeuw J, Morales I: The ICU-HELICS programme: towards European surveillance of hospital-acquired infections in intensive care units. Euro Surveill 2002, 7:127-128.
• [18]Suetens C, Morales I, Savey A, Palomar M, Hiesmayr M, Lepape A, Gastmeier P, Schmit JC, Valinteliene R, Fabry J: European surveillance of ICU-acquired infections (HELICS-ICU): methods and main results. J Hosp Infect 2007, 65(Suppl 2):171-173.
• [19]European Centre for Disease Prevention and Control (ECDC): Annual Epidemiological Report on Communicable Diseases in Europe 2008. Stockholm: ECDC; 2008:16-38.
• [20]European Centre for Disease Prevention and Control (ECDC): Epidemiology of communicable diseases in Europe, 2006. In Annual Epidemiological Report on Communicable Diseases in Europe 2008. Stockholm: ECDC; 2008:289-295.
• [21]Cohen J: A coefficient of agreement for nominal scales. Educ Psychol Meas 1960, 20:37-46.
• [22]Cohen J: Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psych Bull 1968, 70:213-220.
• [23]Minei JP, Hawkins K, Moody B, Uchal LB, Joy K, Christensen LL, Haley RW: Alternative case definitions of ventilator associated pneumonia identify different patients in a surgical intensive care unit. Shock 2000, 14:331-337.
• [24]Wilson A, Gibbons C, Reeves B, Hiodgson B, Liu M, Plummer D, Krukowski ZH, Bruce J, Wilson J, Pearson A: Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients. BMJ 2004, 329:720.
• [25]Gastmeier P, Hentschel J, De Veer I, Obladen M, Rüden H: Device-associated nosocomial infection surveillance in neonatal intensive care using specified criteria for neonates. J Hosp Infect 1998, 38:51-60.
• [26]Beck K, Gastmeier P: Clinical or epidemiologic diagnosis of nosocomial pneumonia: Is there any difference? Am J Infect Control 2003, 31:331-335.
• [27]Harbarth S, Sax H, Gastmeier P: The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 2003, 54:258-266.
• [28]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-174.
• [29]Hansen S, Schwab F, Behnke M, Carsauw H, Heczko P, Klavs I, Lyytikäinen O, Palomar M, Riesenfeld Orn I, Savey A, Szilagyi E, Valinteliene R, Fabry J, Gastmeier P: National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project. J Hosp Infect 2009, 71:66-73.
• [30]Klompas M, Kleinman K, Khan Y, Evans RS, Lloyd JF, Stevenson K, Samore M, Platt R: CDC Prevention Epicenters Program. Rapid and reproducible surveillance for ventilator-associated pneumonia. Clin Infect Dis 2012, 54:370-377.
• [31]Magill SS, Fridkin SK: Improving surveillance definitions for ventilator-associated pneumonia in an era of public reporting and performance measurement. Clin Infect Dis 2012, 54:378-80.