Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm

Abstract

Background: Most surveillance systems for catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) are based on manual chart review. Our objective was to validate a fully automated algorithm for CRBSI and CLABSI surveillance in intensive care units (ICU).

Methods: We developed a fully automated algorithm to detect CRBSI, CLABSI and ICU-onset bloodstream infections (ICU-BSI) in patients admitted to the ICU of a tertiary care hospital in Switzerland. The parameters included in the algorithm were based on a recently performed systematic review. Structured data on demographics, administrative data, central vascular catheter and microbiological results (blood cultures and other clinical cultures) obtained from the hospital's data warehouse were processed by the algorithm. Validation for CRBSI was performed by comparing results with prospective manual BSI surveillance data over a 6-year period. CLABSI were retrospectively assessed over a 2-year period.

Results: From January 2016 to December 2021, 854 positive blood cultures were identified in 346 ICU patients. The median age was 61.7 years [IQR 50-70]; 205 (24%) positive samples were collected from female patients. The algorithm detected 5 CRBSI, 109 CLABSI and 280 ICU-BSI. The overall CRBSI and CLABSI incidence rates determined by automated surveillance for the period 2016 to 2021 were 0.18/1000 catheter-days (95% CI 0.06-0.41) and 3.86/1000 catheter days (95% CI: 3.17-4.65). The sensitivity, specificity, positive predictive and negative predictive values of the algorithm for CRBSI, were 83% (95% CI 43.7-96.9), 100% (95% CI 99.5-100), 100% (95% CI 56.5-100), and 99.9% (95% CI 99.2-100), respectively. One CRBSI was misclassified as an ICU-BSI by the algorithm because the same bacterium was identified in the blood culture and in a lower respiratory tract specimen. Manual review of CLABSI from January 2020 to December 2021 (n = 51) did not identify any errors in the algorithm.

Conclusions: A fully automated algorithm for CRBSI and CLABSI detection in critically-ill patients using only structured data provided valid results. The next step will be to assess the feasibility and external validity of implementing it in several hospitals with different electronic health record systems.

Keywords: Bloodstream infection; CLABSI; Catheter-infection; Digital; Healthcare associated infections; Intensive care unit; Internal validation; Sensitivity; Specificity.

Fig. 1

Fully automated algorithm developed for CRBSI, CLABSI and intensive care unit (ICU) onset BSI detection for patients in the ICU. 1. List of common commensals from the CDC NHSN. 2. Only short term central vascular catheters are considered. 3. Specimens included : respiratory samples, urinary samples, central nervous system samples, abdominal samples, bone and joints samples. 4. This rule applies only to true pathogens and not to common commensal (even if classified as true pathogen on step 3). ICU: intensive care unit; BSI: bloodstream infection; CVC: central vascular catheter; CLABSI: central line associated Bloodstream Infection; CRBSI: Catheter related bloodstream infection; CC: common commensals