Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection
Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection
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DOI：
10.1016/j.ajic.2013.05.024
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发表时间：
2013-12-01
影响因子：
4.9
通讯作者：
Fakih, Mohamad G.
中科院分区：
文献类型：
--
作者：
Hanna, Fadi Al-Qas;Sambirska, Oksana;Fakih, Mohamad G.
背景：美国国家医疗安全网络(NHSN)对导管相关性尿路感染(CAUTI)的定义用于评估CAUTI预防工作的改进情况。我们评估了临床实践是否反映了NHSN的定义。方法：我们评估了2010年7月至2011年6月间住院的所有成人患者，入院后48小时尿液培养首次阳性的患者在留置导尿管时或在拔管后48小时内。数据包括患者的体征、症状和诊断测试；临床医生的诊断；以及传染病(ID)顾问的印象。结果：387例CAUTI患者中，216例(55.8%)使用抗生素治疗，其中119例(30.7%)符合NHSN CAUTI定义，63例(29.9%)符合NHSN CAUTI定义。与NHSN CAUTI定义(n=387)相比，临床医生诊断CAUTI的敏感度、特异度、阳性预测值和阴性预测值分别为62.2%、47%、34.3%和73.7%；与ID咨询师评估(n=211)相比，敏感性、特异度、阳性预测值和阴性预测值分别为100%、57.4%、50%和100%。NHSN CAUTI定义的阳性预测值为35.1%，与ID咨询师的印象(n=211)相比。结论：NHSN CAUTI定义不能反映临床医生或ID咨询师的做法。我们的发现反映了监测定义和临床实践之间的差异。版权所有(C)2013年，感染控制和流行病学专业人士协会。Elsevier Inc.出版。保留所有权利。
Background: The National Healthcare Safety Network (NHSN) definition for catheter-associated urinary tract infection (CAUTI) is used to evaluate improvements in CAUTI prevention efforts. We assessed whether clinician practice was reflective of the NHSN definition.Methods: We evaluated all adult inpatients hospitalized between July 2010 and June 2011, with a first positive urine culture > 48 hours of admission obtained while catheterized or within 48 hours of catheter discontinuation. Data comprised patients' signs, symptoms, and diagnostic tests; clinician's diagnosis; and the impression of the infectious diseases (ID) consultant. The clinician's practice was compared with the NHSN definition and the ID consultant's impression.Results: Antibiotics were initiated by clinicians to treat CAUTI in 216 of 387 (55.8%) cases, with 119 of 387 (30.7%) fitting the NHSN CAUTI definition, and 63 of 211 (29.9%) considered by ID to have a CAUTI. The sensitivity, specificity, and positive and negative predictive values of a clinician diagnosis of CAUTI were 62.2%, 47%, 34.3%, and 73.7% when compared with NHSN CAUTI definition (n = 387) and 100%, 57.4%, 50%, and 100% when compared with the ID consultant evaluation (n = 211), respectively. The positive predictive value of the NHSN CAUTI definition was 35.1% when compared with the ID consultant's impression (n = 211).Conclusion: NHSN CAUTI definition did not reflect clinician or ID consultant practices. Our findings reflect the differences between surveillance definitions and clinical practice. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.