Automatic detection of patients with nosocomial infection by a computer-based surveillance system:: A validation study in a general hospital
Automatic detection of patients with nosocomial infection by a computer-based surveillance system:: A validation study in a general hospital
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DOI：
10.1086/502685
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发表时间：
2006-05-01
影响因子：
4.5
通讯作者：
Vilarasau, J.
中科院分区：
文献类型：
--
作者：
Pokorny, L.;Rovira, A.;Vilarasau, J.
Objective.目的：验证一种用于重症监护病房（ICU）患者医院感染（NI）检测的自动化系统。对医院信息系统数据的回顾性分析。我们应用了3种不同的NI怀疑标准（阳性微生物学报告、抗生素使用和临床感染诊断），并将结果与同期（1999-2002年）在ICU进行的前瞻性NI发生率研究的结果进行了比较。西班牙巴塞罗那一家拥有250个床位的综合医院。从1999年4月15日到2002年6月30日，1380名患者被送入ICU。其中，1043人在ICU停留超过24小时，并被纳入研究。242例患者（23.2%）至少存在一项NI怀疑标准; 184例患者（17.6%）存在2项标准; 112例患者（11.7%）存在所有3项标准。医院信息系统数据与前瞻性研究结果的比较表明，2个标准的组合显示出最令人满意的灵敏度（94.3%; 95%置信区间[CI]，79.5%-99.0%）和特异性（83.6%; 95% CI，76.8%-88.9%）。阳性预测值为55.9%（95%CI，42.5%-68.6%）;阴性预测值为98.5%（95%CI，94.2%-99.7%）。该系统可为90.4%的NI指定感染部位。医院信息系统是一个有用的工具，回顾性检测患者在ICU住院期间的NI。鉴于其高度敏感性，它可能是有用的，作为一个警报NI团队。
Objective. To validate an automated system for the detection of patients with nosocomial infection ( NI) in an intensive care unit (ICU).Design. Retrospective analysis of data from the hospital information system. We applied 3 different NI suspicion criteria (positive microbiology reports, antibiotic administration, and diagnosis of clinical infection) and compared the results to those of a prospective NI incidence study done in the ICU during the same period (1999-2002).Setting. A 250-bed general hospital in Barcelona, Spain.Patients. From April 15, 1999, through June 30, 2002, 1380 patients were admitted to the ICU. Of these, 1043 had an ICU stay of more than 24 hours and were included in the study.Results. At least one NI suspicion criterion was present for 242 patients (23.2%); 2 criteria were present for 184 patients (17.6%); and all 3 criteria were present for 112 (11.7%). Comparison of hospital information system data to the results of the prospective study indicated that the combination of 2 criteria demonstrated the most satisfactory sensitivity (94.3%; 95% confidence interval [CI], 79.5%-99.0%) and specificity (83.6%; 95% CI, 76.8%-88.9%). The positive predictive value was 55.9% (95% CI, 42.5%-68.6%); the negative predictive value was 98.5% (95% CI, 94.2%-99.7%). The system could assign a site of infection for 90.4% of the NIs detected.Conclusion. The hospital information system was a useful tool for retrospectively detecting patients with an NI during the ICU stay. Given its high sensitivity, it may be useful as an alert for the NI team.