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首页> 外文期刊>South African medical journal = >Surveillance of healthcare-associated infection in hospitalised South African children: Which method performs best?
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Surveillance of healthcare-associated infection in hospitalised South African children: Which method performs best?

机译：南非住院儿童医疗保健相关感染的监测：哪种方法效果最好？

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BACKGROUND. In 2012, the South African (SA) National Department of Health mandated surveillance of healthcare-associated infection (HAI), but made no recommendations of appropriate surveillance methods. METHODS. Prospective clinical HAI surveillance (the reference method) was conducted at Tygerberg Childrens Hospital, Cape Town, from 1 May to 31 October 2015. Performance of three surveillance methods (point prevalence surveys (PPSs), laboratory surveillance and tracking of antimicrobial prescriptions) was compared with the reference method using surveillance evaluation guidelines. Factors associated with failure to detect HAI were identified by logistic regression analysis. RESULTS. The reference method detected 417 HAIs among 1 347 paediatric hospitalisations (HAI incidence of 31/1000 patient days; 95% confidence interval (CI) 28.2 - 34.2). Surveillance methods had variable sensitivity (S) and positive predictive value (PPV): PPS S = 24.9% (95% CI 21-29.3), PPV = 100%; laboratory surveillance S = 48.4% (95% CI 43.7 - 53.2), PPV = 55.2% (95% CI 50.1-60.2); and antimicrobial prescriptions S = 66.4% (95% CI 61.8 - 70.8%), PPV = 88.5% (95% CI 84.5 - 91.6). Combined laboratory-antimicrobial surveillance achieved superior HAI detection (S = 84.7% (95% CI 80.9 - 87.8%), PPV = 97% (95% CI 94.6 - 98.4%)). Factors associated with failure to detect HAI included patient transfer (odds ratio (OR) 2.0), single HAI event (OR 2.8), age category 1 - 5 years (OR 2.1) and hospitalisation in a general ward (OR 2.3). CONCLUSIONS. Repeated PPSs, laboratory surveillance and/or antimicrobial prescription tracking are feasible HAI surveillance methods for low-resource settings. Combined laboratory-antimicrobial surveillance achieved the best sensitivity and PPV. SA paediatric healthcare facilities should individualise HAI surveillance, selecting a method suited to available resources and practice context.
机译：背景。 2012年，南非（SA）国家卫生部（National Department of Health）要求对医疗保健相关感染（HAI）进行监视，但未提出适当监视方法的建议。方法。 2015年5月1日至10月31日，在开普敦的Tygerberg儿童医院进行了临床前瞻性HAI监测（参考方法）。比较了三种监测方法（点流行度调查（PPS），实验室监测和抗菌药物处方追踪）的执行情况使用监督评估指南的参考方法。通过逻辑回归分析确定与未能检测到HAI相关的因素。结果。该参考方法在1 347例儿科住院病例中检测到417 HAI（HAI发生率为31/1000患者日; 95％置信区间（CI）为28.2-34.2）。监测方法具有可变的敏感性（S）和阳性预测值（PPV）：PPS S = 24.9％（95％CI 21-29.3），PPV = 100％;实验室监视S = 48.4％（95％CI 43.7-53.2），PPV = 55.2％（95％CI 50.1-60.2）;和抗菌药物处方S = 66.4％（95％CI 61.8-70.8％），PPV = 88.5％（95％CI 84.5-91.6）。实验室-微生物联合监测实现了出色的HAI检测（S = 84.7％（95％CI 80.9-87.8％），PPV = 97％（95％CI 94.6-98.4％）。与无法检测到HAI相关的因素包括患者转移（优势比（OR）2.0），单次HAI事件（OR 2.8），1-5岁年龄段（OR 2.1）以及在普通病房住院（OR 2.3）。结论。重复的PPS，实验室监视和/或抗菌处方跟踪是用于低资源环境的可行HAI监视方法。实验室-微生物联合监测实现了最佳灵敏度和PPV。 SA儿科医疗机构应个性化HAI监测，选择适合现有资源和实践环境的方法。

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