Ventilator-associated pneumonia surveillance using two methods.

Adult Aged Algorithms Female Hospitals Humans Male Middle Aged Pneumonia, Ventilator-Associated / epidemiology Prospective Studies Public Health Surveillance / methods Scotland / epidemiology Sentinel Surveillance
Critical care Infection surveillance Mechanical ventilation ventilator-associated pneumonia

Journal

The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166

Informations de publication

Date de publication:
Apr 2020
Historique:
received: 29 11 2019
accepted: 28 01 2020
pubmed: 9 2 2020
medline: 14 1 2021
entrez: 9 2 2020
Statut: ppublish

Résumé

Ventilator-associated pneumonia surveillance is used as a quality indicator due to concerns that some cases may be preventable and may contribute to mortality. Various surveillance criteria exist for the purposes of national reporting, but a large-scale direct comparison has not been conducted. A prospective cohort study applied two routinely used surveillance criteria for ventilator-associated pneumonia from the European Centre for Disease Control and the American Centers for Disease Control to all patients admitted to two large general intensive care units. Diagnostic rates and concordance amongst diagnostic events were compared. A total of 713 at-risk patients were identified during the study period. The European surveillance algorithm returned a rate of 4.6 cases of ventilator-associated pneumonia per 1000 ventilation days (95% confidence interval 3.1-6.6) and the American surveillance system a rate of 5.4 (3.8-7.5). The concordance between diagnostic events was poor (Cohen's Kappa 0.127 (-0.003 to 0.256)). The algorithms yield similar rates, but the lack of event concordance reveals the absence of inter-algorithm agreement for diagnosing ventilator-associated pneumonia, potentially undermining surveillance as an indicator of care quality.

Sections du résumé

BACKGROUND BACKGROUND
Ventilator-associated pneumonia surveillance is used as a quality indicator due to concerns that some cases may be preventable and may contribute to mortality. Various surveillance criteria exist for the purposes of national reporting, but a large-scale direct comparison has not been conducted.
METHODS METHODS
A prospective cohort study applied two routinely used surveillance criteria for ventilator-associated pneumonia from the European Centre for Disease Control and the American Centers for Disease Control to all patients admitted to two large general intensive care units. Diagnostic rates and concordance amongst diagnostic events were compared.
FINDINGS RESULTS
A total of 713 at-risk patients were identified during the study period. The European surveillance algorithm returned a rate of 4.6 cases of ventilator-associated pneumonia per 1000 ventilation days (95% confidence interval 3.1-6.6) and the American surveillance system a rate of 5.4 (3.8-7.5). The concordance between diagnostic events was poor (Cohen's Kappa 0.127 (-0.003 to 0.256)).
CONCLUSIONS CONCLUSIONS
The algorithms yield similar rates, but the lack of event concordance reveals the absence of inter-algorithm agreement for diagnosing ventilator-associated pneumonia, potentially undermining surveillance as an indicator of care quality.

Identifiants

DOI: 10.1016/j.jhin.2020.01.020 PMID: 32035121
pubmed: 32035121
pii: S0195-6701(20)30044-X
doi: 10.1016/j.jhin.2020.01.020
pii:
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

522-528

Informations de copyright

Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.

Auteurs

T H Craven (TH)

Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK; Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK; Clinical Microbiology, NHS Lothian Infection Service, Royal Infirmary of Edinburgh, Edinburgh, UK. Electronic address: Thomas.craven@ed.ac.uk.

G Wojcik (G)

Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK.

J McCoubrey (J)

Health Protection Scotland, Glasgow, UK.

O Brooks (O)

Clinical Microbiology, NHS Lothian Infection Service, Royal Infirmary of Edinburgh, Edinburgh, UK.

E Grant (E)

Western General Hospital, Edinburgh, UK.

S Keating (S)

Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK.

J Reilly (J)

Health Protection Scotland, Glasgow, UK.

I F Laurenson (IF)

Clinical Microbiology, NHS Lothian Infection Service, Royal Infirmary of Edinburgh, Edinburgh, UK.

K Kefala (K)

Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK; Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK; Clinical Microbiology, NHS Lothian Infection Service, Royal Infirmary of Edinburgh, Edinburgh, UK.

T S Walsh (TS)

Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK; Edinburgh Critical Care Research Group, University of Edinburgh, Edinburgh, UK; Clinical Microbiology, NHS Lothian Infection Service, Royal Infirmary of Edinburgh, Edinburgh, UK.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Sciences de l'information › Méthodologies informatiques › Algorithmes › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie iatrogène › Infection croisée › Pneumonie associée aux soins › Pneumopathie infectieuse sous ventilation assistée › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Surveillance de la population › Surveillance de la santé publique › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Régions géographiques › Europe › Royaume-Uni › Écosse › Ventilator-associated pneumonia surveillance...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Surveillance de la population › Surveillance sentinelle › Ventilator-associated pneumonia surveillance...