Volume 10, Number 9—September 2004
Computer Algorithms To Detect Bloodstream Infections
|Determinationb||Computer rule||NNIS definitions|
||(A) Acquired blood culture >3 days after hospital admission
||No evidence infection present or incubating at time of hospital admission, unless infection was related to previous admission to this hospital
|Infection||(B1) Microbiology data: pathogen other than CSCc cultured from blood, or >2 CSC isolates recovered from blood within 5 days of initial positive blood culture||Patient has at least one sign or symptom: fever (>38°C), chills, or hypotension and at least one of the following:
pathogen cultured from >1 blood cultures, CSC cultured from >2 blood cultures drawn on separate occasions, CSC cultured from at least 1 blood culture from patient with intravenous line, and physician institutes appropriate antimicrobial drug therapy
|(B2) Microbiology and pharmacy data: pathogen cultured from blood or >2 CSCd isolates within 5 days of initial positive blood culture, or CSC cultured from blood once and vancomycin administered within 3 days before until 1 day after isolate identification
|Secondary bloodstream infection (BSI)d
||(C1) Time restricted: organism recovered from blood also recovered from a nonblood culture, 3–7 days after the blood culture acquisition dated||The organism cultured from the blood is related to an infection at another site
|(C2) Length of stay: organism recovered from blood also recovered from a nonblood culture during the entire length of stayd
|Central-venous catheter (CVC) associatede||(D) No algorithm developed, all BSI were considered CVC associated||Vascular access device that terminated at or close to heart or one of great vessels within the 48-hour period before BSI developed|
aNNIS, National Nosocomial Infection Surveillance; CSC, common skin contaminant; BSI, bloodstream infection.
bFor each determination, if the computer rule or NNIS definition was not met, the isolate was considered as one the following: community acquired, a contaminant, primary BSI, or not CVC associated.
cWe used the examples of CSCs listed in the NNIS manual: diphtheroids, Bacillus spp., Propionibacterium spp., coagulase-negative staphylococci, or micrococci.
dCatheter tip and stool cultures were excluded for both algorithms. CSCs had to be cultured from a wound for the BSI to be considered as a secondary BSI.
eIncludes tunneled or nontunneled catheters inserted into the subclavian, jugular, or femoral veins; pulmonary artery catheters; hemodialysis catheter; totally implanted devices (ports); peripherally inserted central catheters; and introducer sheaths.