Use of Statistical Process Control Methods for Early Detection of Healthcare Facility-Associated Nontuberculous Mycobacteria Outbreaks: A Single-Center Pilot Study.
Use of Statistical Process Control Methods for Early Detection of Healthcare Facility-Associated Nontuberculous Mycobacteria Outbreaks: A Single-Center Pilot Study.
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使用统计过程控制方法早期检测医疗机构相关的非结核分枝杆菌爆发：单中心试点研究。
DOI：
10.1093/cid/ciac923
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Anderson,DeverickJ
中科院分区：
文献类型：
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作者：
Baker,ArthurW;Maged,Ahmed;Haridy,Salah;Stout,JasonE;Seidelman,JessicaL;Lewis,SarahS;Anderson,DeverickJ
背景非结核分枝杆菌(NTM)是越来越多与医疗机构相关(HCFA)感染和暴发有关的新出现的病原体。我们分析了统计过程控制(SPC)方法在检测HCFA NTM暴发方面的表现。方法对某三级护理医院2013-2016年间发生的3起NTM疫情进行回顾性分析。暴发包括获得肺脓肿复合体(MABC)、心脏手术相关的肺外MABC感染和支气管镜检查相关的禽型分支杆菌复合体(MAC)假性暴发。我们分析了MABC呼吸道培养阳性、MABC非呼吸道培养阳性和MAC支气管肺泡灌洗培养阳性的患者的每月病例率。对于每一次暴发，我们使用这些比率来构建具有滚动基线窗口的试点移动平均(MA)SPC图。我们还探索了许多替代控制图的性能，包括指数加权MA图、休哈特图和累积和图。结果试点MA图在疫情开始后2个月内检测到每次疫情，平均比实际疫情检测早6个月。在总共117个月的暴发前和暴后监测中，没有出现假阳性的SPC信号(特异度为100%)。预期使用该图表进行非传染性疾病监测本可预防估计108例非传染性疾病病例。6种高性能替代图在发病月份内发现了所有暴发，其特异度在85.7%~94.9%之间。结论SPC方法有可能显著改善HCFA NTM监测，促进暴发的早期发现和NTM感染的预防。还需要进一步的研究来确定SPC在其他环境中预期的HCFA-NTM监测中的最佳应用。
BackgroundNontuberculous mycobacteria (NTM) are emerging pathogens increasingly implicated in healthcare facility–associated (HCFA) infections and outbreaks. We analyzed the performance of statistical process control (SPC) methods in detecting HCFA NTM outbreaks.MethodsWe retrospectively analyzed 3 NTM outbreaks that occurred from 2013 to 2016 at a tertiary care hospital. The outbreaks consisted of pulmonaryMycobacterium abscessuscomplex (MABC) acquisition, cardiac surgery–associated extrapulmonary MABC infection, and a bronchoscopy-associated pseudo-outbreak ofMycobacterium aviumcomplex (MAC). We analyzed monthly case rates of unique patients who had positive respiratory cultures for MABC, non-respiratory cultures for MABC, and bronchoalveolar lavage cultures for MAC, respectively. For each outbreak, we used these rates to construct a pilot moving average (MA) SPC chart with a rolling baseline window. We also explored the performance of numerous alternative control charts, including exponentially weighted MA, Shewhart, and cumulative sum charts.ResultsThe pilot MA chart detected each outbreak within 2 months of outbreak onset, preceding actual outbreak detection by an average of 6 months. Over a combined 117 months of pre-outbreak and post-outbreak surveillance, no false-positive SPC signals occurred (specificity, 100%). Prospective use of this chart for NTM surveillance could have prevented an estimated 108 cases of NTM. Six high-performing alternative charts detected all outbreaks during the month of onset, with specificities ranging from 85.7% to 94.9%.ConclusionsSPC methods have potential to substantially improve HCFA NTM surveillance, promoting early outbreak detection and prevention of NTM infections. Additional study is needed to determine the best application of SPC for prospective HCFA NTM surveillance in other settings.