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Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm
Gaud Catho1,2, Loïc Fortchantre3, Daniel Teixeira3
1Infection Control Programme and World Health Organization Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. Gaud.catho@hcuge.ch.
Insights
A new automated algorithm accurately detects catheter-related and central line-associated bloodstream infections in intensive care units. This method offers a valid alternative to manual chart review for CRBSI and CLABSI surveillance.
Area of Science:
- Infection Control
- Clinical Informatics
- Epidemiology
Background:
- Traditional surveillance for bloodstream infections relies on manual chart review.
- Automated surveillance systems offer potential for improved efficiency and accuracy.
- Validating automated algorithms is crucial for their clinical implementation.
Purpose of the Study:
- To validate a fully automated algorithm for detecting catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs).
- To compare the performance of the automated algorithm against manual surveillance data.
Main Methods:
- Development of a fully automated algorithm using structured data (demographics, central vascular catheter, microbiological results) from a hospital data warehouse.
- Algorithm parameters based on a systematic review.
- Validation of CRBSI detection against prospective manual surveillance (6 years).
- Retrospective assessment of CLABSI detection (2 years).
Main Results:
- The algorithm processed data from 346 ICU patients between 2016-2021, identifying 854 positive blood cultures.
- High performance metrics for CRBSI detection: 83% sensitivity, 100% specificity, 100% positive predictive value, and 99.9% negative predictive value.
- Automated surveillance yielded CRBSI incidence of 0.18/1000 catheter-days and CLABSI incidence of 3.86/1000 catheter-days.
- One CRBSI misclassification noted; manual review found no errors in CLABSI detection.
Conclusions:
- A fully automated algorithm using structured data is a valid tool for CRBSI and CLABSI surveillance in critically-ill patients.
- The algorithm demonstrates high accuracy comparable to manual methods.
- Future research should focus on assessing implementation feasibility and external validity across different healthcare systems.
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.
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