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Volume 10, Number 9—September 2004
Research

Computer Algorithms To Detect Bloodstream Infections

William E. Trick*Comments to Author , Brandon M. Zagorski†, Jerome I. Tokars*, Michael O. Vernon†, Sharon F. Welbel†‡§, Mary F. Wisniewski†‡, Chesley Richards*, and Robert A. Weinstein†‡§
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Chicago Antimicrobial Resistance Project, Chicago, Illinois, USA; ‡Cook County Hospital, Chicago, Illinois, USA; §Rush Medical College, Chicago, Illinois, USA

Main Article

Table 3

Comparing alternative methods for determining if positive blood cultures represented a hospital-acquired, primary, central-venous catheter–associated bloodstream infection, Cook County and Provident Hospitals, Chicago, Illinoisa

Method % sensitivity % specificity % PVP % PVN κ (95% CI)
Cook County Hospital (n = 104)
  Investigator review (reference method)
  Infection control professional review 67 75 62 79 0.41 (0.24–0.59)
  Positive blood culture + CVC determinationb 100 55 57 100 0.48 (0.35–0.62)
  Worst computer algorithm (rules A, B1, C1, D)c 72 74 62 81 0.44 (0.27–0.62)
  Best computer algorithm (rules A, B2, C2, D)d 79 72 63 85 0.49 (0.33–0.66)
  Computer algorithm + CVC determinationb 79 88 79 88 0.67 (0.52–0.82)e
Provident Hospital (n = 31)
  Investigator review (reference method)
  Infection control professional review 56 68 42 79 0.22 (–0.13–0.56)
  Positive blood culture + CVC determinationb 100 59 50 100 0.46 (0.20–0.70)
  Worst computer algorithm (rules A, B1, C1, D)c 78 64 53 88 0.35 (0.04–0.65)
  Best computer algorithm (rules A, B2, C2, D)d 89 68 53 94 0.48 (0.19–0.76)
  Computer algorithm + CVC determinationb 89 95 89 95 0.84 (0.63–1.0)e
Summary for both hospitals (n = 135)
  Investigator review (reference method)
  Infection control professional review 65 74 57 79 0.37 (0.21–0.53)e
  Positive blood culture + CVC determinationb 100 56 56 100 0.48 (0.36–0.60)
  Worst computer algorithm (rules A, B1, C1, D)c 72 74 62 81 0.42 (0.27–0.57)
  Best computer algorithm (rules A, B2, C2, D)d 81 72 62 87 0.49 (0.35–0.63)
  Computer algorithm + CVC determinationb 81 90 81 90 0.73 (0.61–0.85)e

aPVP, predictive value positive; PVN, predictive value negative, CI, confidence interval.
bPresence of a central-venous catheter (CVC) determined by investigator medical record review.
cThe computer algorithm with the worst agreement, which used only microbiology data for the determination of infection vs. contaminant (rule B1, Table 1), and an abbreviated time period for the determination of primary vs. secondary (rule C1, Table 1).
dThe computer algorithm with the best agreement, which used the microbiology and pharmacy data for the determination of infection vs. contaminant (rule B2, Table 1), and the entire length of stay for the determination of primary vs. secondary (rule C2, Table 1).
eAgreement between investigator review and the best performing computer algorithm plus CVC determination was significantly better than between investigator and infection control professional reviews, i.e., p value < 0.05.

Main Article

Page created: March 25, 2011
Page updated: March 25, 2011
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