Hospital-onset bacteraemia and fungaemia as a novel automated surveillance indicator: results from four European university hospitals, 2018 to 2022

BACKGROUNDConventional manual surveillance of healthcare-associated infections is labour-intensive and therefore often restricted to areas with high-risk patients. Fully automated surveillance of hospital-onset bacteraemia and fungaemia (HOB) may facilitate hospital-wide surveillance.AIMTo develop an algorithm and minimal dataset (MDS) required for automated surveillance of HOB and apply it to real-life routine data in four European hospitalsMETHODSThrough consensus discussion, a HOB definition with MDS suitable for automated surveillance was developed and applied in a retrospective multicentre observational study including all adult patients admitted to hospitals in the Netherlands, Germany, Sweden and Switzerland (2018-22). Annual HOB rates were calculated per 1,000 patient days for hospital, intensive care unit (ICU) and non-ICU settings.RESULTSHOB was defined as a positive blood culture with a recognised pathogen 2 or more days after hospital admission. For common commensals, two blood cultures with the same commensal within 2 days were required. HOB rates were comparable between the four hospitals (1.0-2.2/1,000 patient days). HOB rates were substantially higher in ICU than non-ICU settings, and HOB with common commensals accounted for 14.8-28.2% of all HOB. HOB rates per 1,000 patient days were consistent over time, but higher in 2020-21. HOB caused by Staphylococcus aureus comprised 8.4-16.0% of all HOB.CONCLUSIONAutomated HOB surveillance using a common definition was feasible and reproducible across four European hospitals. Future studies should investigate clinical relevance and preventability of HOB, and focus on strategies to make the automated HOB metric an actionable infection control tool.