Inconsistencies exist in reporting of bloodstream infections
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Further analysis of bloodstream infections in patients on hemodialysis uncovered significant discordance between the submitted and primary culture data, according to an audit.
“Patients with dialysis-dependent end-stage kidney disease suffer high rates of infections. Bloodstream infections (BSIs) are the major cause of fatal infection and third leading cause of death,” Anuja Shah, BA, of the University of Virginia, and colleagues wrote.
To assess the accuracy of pathogen reporting to the National Health Care Safety Network (NHSN), Shah and colleagues conducted a retrospective pathogen data audit on 2016 NHSN BSI reporting. The audit was carried out on an 11-facility hospital-owned academic dialysis program. Researchers compared submitted infection events with original microbiology culture data from source laboratories. Using NHSN submissions and a dialysis medical record system, researchers obtained demographic, vascular access and BSI scores/etiologies. The researchers categorized the report of each infection event as complete, incomplete, inaccurate or erroneous.
The study period included 91 infection events and 102 positive blood cultures, with a maximum of three cultures per event. Summary data remained consistent during the audit with 43% of BSI events as access-related and 77% occurring in patients with central venous catheters. Also, 64% of cultures were caused by Staphylococcus species of gram-positive bacteria.
However, when additional analysis was conducted, researchers uncovered discrepancies: 64% of cultures were reported accurate and complete but 36% were incomplete, inaccurate or reported a BSI culture when a different infection type occurred. The most common error was incomplete reporting, impacting 22.5% of cultures. In addition, 6.7% of cultures were erroneously reported due to wound cultures getting submitted as BSI cultures.
The researchers recognized the small study size and lack of access to under-reporting hindered the study findings.
“The high error rate found has significant implications for facility and, if generalizable, wider infection control efforts,” Shah and colleagues wrote. They added, “We believe policy makers should advocate for a national dialysis BSI reporting system where automated culture data is sourced directly from labs to a national clearinghouse. This would effectively eliminate under-reporting (and over-reporting), improve pathogen reporting accuracy, and remove facilities the conflict of interest inherent in self-reporting.”
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