The accuracy of fully automated algorithms for surveillance of healthcare-associated urinary tract infections in hospitalized patients.

BACKGROUND: Surveillance for healthcare-associated infections such as healthcare-associated urinary tract infections (HA-UTI) is important for directing resources and evaluating interventions. However, traditional surveillance methods are resource-intensive and subject to bias. AIM: To develop and validate a fully automated surveillance algorithm for HA-UTI using electronic health record (EHR) data. METHODS: Five algorithms were developed using EHR data from 2979 admissions at Karolinska University Hospital from 2010 to 2011: (1) positive urine culture (UCx); (2) positive UCx + UTI codes (International Statistical Classification of Diseases and Related Health Problems, 10th revision); (3) positive UCx + UTI-specific antibiotics; (4) positive UCx + fever and/or UTI symptoms; (5) algorithm 4 with negation for fever without UTI symptoms. Natural language processing (NLP) was used for processing free-text medical notes. The algorithms were validated in 1258 potential UTI episodes from January to March 2012 and results extrapolated to all UTI episodes within this period (N = 16,712). The reference standard for HA-UTIs was manual record review according to the European Centre for Disease Prevention and Control (and US Centers for Disease Control and Prevention) definitions by trained healthcare personnel. FINDINGS: Of the 1258 UTI episodes, 163 fulfilled the ECDC HA-UTI definition and the algorithms classified 391, 150, 189, 194, and 153 UTI episodes, respectively, as HA-UTI. Algorithms 1, 2, and 3 had insufficient performances. Algorithm 4 achieved better performance and algorithm 5 performed best for surveillance purposes with sensitivity 0.667 (95% confidence interval: 0.594-0.733), specificity 0.997 (0.996-0.998), positive predictive value 0.719 (0.624-0.807) and negative predictive value 0.997 (0.996-0.997). CONCLUSION: A fully automated surveillance algorithm based on NLP to find UTI symptoms in free-text had acceptable performance to detect HA-UTI compared to manual record review. Algorithms based on administrative and microbiology data only were not sufficient.

Risk factors for community-onset bloodstream infection with extended-spectrum ß-lactamase-producing Enterobacteriaceae: national population-based case-control study.

OBJECTIVES: The aim was to investigate risk factors for community-onset bloodstream infections with extended-spectrum ß-lactamase-producing Enterobacteriaceae (EPE BSI). METHODS: It is mandatory to report EPE BSI to a national register at the Public Health Agency of Sweden. Using this register, we performed a population-based case-control study from 2007 to 2012 of 945 cases and 9390 controls. Exposure data on comorbidity, hospitalization, in- and outpatient antibiotic consumption and socio-economic status were collected from hospital and health registers. RESULTS: The overall incidence of EPE BSI was 1.7 per 100 000 person-years. The 30-day mortality was 11.3%. Urological disorders inferred the highest EPE BSI risk, adjusted odds ratio (aOR) 4.32 (95% Confidence Interval (CI) 3.41-5.47), followed by immunological disorders, aOR 3.54 (CI 2.01-6.23), haematological malignancy, aOR 2.77 (CI 1.57-4.87), solid tumours, aOR 2.28 (1.76-2.94) and diabetes, aOR 2.03 (1.58-2.61). Consumption of fluoroquinolones or mostly non-EPE-active antibiotics with selective Gram-negative spectrum of activity within the previous 3 months was associated with EPE BSI, aORs 5.52 (CI 2.8-11.0) and 3.8, CI 1.9-7.7) respectively. There was a dose-response relationship in EPE BSI risk with increasing number of consecutive regimens. Antibiotic consumption >3 months before EPE BSI was not associated with increased risk. Higher age, malignancies and education ≤12 years (aORs >2) were associated with increased 30-day mortality. CONCLUSIONS: Targeted interventions should be directed towards improving care for patients with immunosuppression, urological disorders and subjects with lower socio-economic status. Antibiotic stewardship should focus on reduction of fluoroquinolones.

Narrow-spectrum ß-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study.

OBJECTIVES: To assess the clinical effect of empirical treatment with narrow-spectrum ß-lactam monotherapy (NSBM) versus broad-spectrum ß-lactam monotherapy (BSBM) in non-severe community-acquired pneumonia (CAP). METHODS: Hospitalized patients ≥18 years with CAP who received initial NSBM or BSBM, with a severity score according to CRB-65≤2 (C=confusion, R=respiratory rate >30/min, B=systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg, 65= ≥65 years), in the Swedish Pneumonia Register from 2008 to 2011 were included. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, treatment at intensive care unit (ICU), and length of stay (LOS). Propensity score matching was performed to account for differences in baseline characteristics. RESULTS: There were 5961 patients with CRB-65≤1 and 1344 patients with CRB-65=2. In the propensity score matched cohorts the 30-day mortality was 40/1827 (2.2%) with NSBM and 56/1827 (3.1%) with BSBM in CRB-65≤1, and 57/524 (10.9%) and 51/524 (9.7%), respectively, in CRB-65=2. No significant differences in 30-day mortality were observed between NSBM and BSBM in patients with CRB-65≤1 or CRB-65=2, OR 1.41 (95% CI 0.94-2.14) and 0.88 (95% CI 0.59-1.32), respectively. There was no significant difference in 90-day mortality. Patients who received BSBM were more often treated at ICU and had longer LOS. CONCLUSIONS: Empirical NSBM appears to be effective in the majority of hospitalized immunocompetent adults with non-severe CAP and should be further evaluated in randomized trials.

Antibiotic prescriptions and laboratory-confirmed cases of Mycoplasma pneumoniae during the epidemic in Sweden in 2011.

Swedish laboratories reported an increase of Mycoplasma pneumoniae during the autumn 2011. Data from the laboratory in Skövde, covering 12.9% of the Swedish population, indicate an approximate increase in the number of laboratory-confirmed cases in the whole country, from around 3,500 in 2009 to 11,100 in 2011. Antibiotics are recommended only for pneumonia, not bronchitis, but compared with the autumn 2009, 42,652 more prescriptions of doxycycline and macrolides were registered in the autumn 2011.

Basic Surveillance Network, a European database for surveillance data on infectious diseases.

The Basic Surveillance Network was started in 2000 and is one of the networks on infectious diseases funded by the European Commission. The network collects and makes readily available basic surveillance data on infectious diseases from all the 'old' (pre-2004) European Union member states. The aim is to provide easy access to descriptive data that already exist in national databases, so that it is possible to monitor and compare incidence trends for infectious diseases in the EU member states. The list of diseases covered by the network has recently been expanded from 10 initial 'pilot' diseases to over 40 diseases listed by the EU to be under surveillance. In the near future, the new member states will be invited to participate in the network. Data are case-based and comprise date of onset of disease, age and sex. Only a very short list of disease specific additional variables, such as country of infection or immunisation status, is collected. Classification of cases (possible, probable, confirmed) is specified according to EU case definitions. The participants of the network have access to an internal web site were all the data is presented in tables and graphs. An open website is available for the public at https://www.eubsn.org./BSN/

Basic Surveillance Network, a European database for surveillance data on infectious diseases.

The Basic Surveillance Network was started in 2000 and is one of the networks on infectious diseases funded by the European Commission. The network collects and makes readily available basic surveillance data on infectious diseases from all the 'old' (pre-2004) European Union member states. The aim is to provide easy access to descriptive data that already exist in national databases, so that it is possible to monitor and compare incidence trends for infectious diseases in the EU member states. The list of diseases covered by the network has recently been expanded from 10 initial 'pilot' diseases to over 40 diseases listed by the EU to be under surveillance. In the near future, the new member states will be invited to participate in the network. Data are case-based and comprise date of onset of disease, age and sex. Only a very short list of disease specific additional variables, such as country of infection or immunisation status, is collected. Classification of cases ( possible, probable, confirmed) is specified according to EU case definitions. The participants of the network have access to an internal web site were all the data is presented in tables and graphs. An open website is available for the public at https://www.eubsn.org./BSN/.