Linking surveillance and clinical data for evaluating trends in bloodstream infection rates in neonatal units in England


Autoři: Caroline Fraser aff001;  Berit Muller-Pebody aff002;  Ruth Blackburn aff003;  Jim Gray aff004;  Sam J. Oddie aff005;  Ruth E. Gilbert aff001;  Katie Harron aff001
Působiště autorů: UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom aff001;  National Infection Service, Public Health England, London, United Kingdom aff002;  Institute of Health Informatics, University College London, London, United Kingdom aff003;  Microbiology, Birmingham Women’s & Children’s Hospitals, Birmingham, United Kingdom aff004;  Bradford Neonatology, Bradford Royal Infirmary, Bradford, United Kingdom aff005;  Centre for Reviews and Dissemination, University of York, York, United Kingdom aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226040

Souhrn

Objective

To evaluate variation in trends in bloodstream infection (BSI) rates in neonatal units (NNUs) in England according to the data sources and linkage methods used.

Methods

We used deterministic and probabilistic methods to link clinical records from 112 NNUs in the National Neonatal Research Database (NNRD) to national laboratory infection surveillance data from Public Health England. We calculated the proportion of babies in NNRD (aged <1 year and admitted between 2010–2017) with a BSI caused by clearly pathogenic organisms between two days after admission and two days after discharge. We used Poisson regression to determine trends in the proportion of babies with BSI based on i) deterministic and probabilistic linkage of NNRD and surveillance data (primary measure), ii) deterministic linkage of NNRD-surveillance data, iii) NNRD records alone, and iv) linked NNRD-surveillance data augmented with clinical records of laboratory-confirmed BSI in NNRD.

Results

Using deterministic and probabilistic linkage, 5,629 of 349,740 babies admitted to a NNU in NNRD linked with 6,660 BSI episodes accounting for 38% of 17,388 BSI records aged <1 year in surveillance data. The proportion of babies with BSI due to clearly pathogenic organisms during their NNU admission was 1.0% using deterministic plus probabilistic linkage (primary measure), compared to 1.0% using deterministic linkage alone, 0.6% using NNRD records alone, and 1.2% using linkage augmented with clinical records of BSI in NNRD. Equivalent proportions for babies born before 32 weeks of gestation were 5.0%, 4.8%, 2.9% and 5.9%. The proportion of babies who linked to a BSI decreased by 7.5% each year (95% confidence interval [CI]: -14.3%, -0.1%) using deterministic and probabilistic linkage but was stable using clinical records of BSI or deterministic linkage alone.

Conclusion

Linkage that combines BSI records from national laboratory surveillance and clinical NNU data sources, and use of probabilistic methods, substantially improved ascertainment of BSI and estimates of BSI trends over time, compared with single data sources.

Klíčová slova:

Blood – Clinical laboratories – England – Government laboratories – Chi square tests – Infectious disease surveillance – Neonatal care – Neonates


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Článek vyšel v časopise

PLOS One


2019 Číslo 12