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Iman Fakih et al
Table 2. Posterior Summary of the Incidence Rate Ratios of Hospital Characteristics for Healthcare-Associated Bloodstream Infections and the Most Common Subtypes for the Cohort and Hospitals that Participated in BACTOT for <10 Years
Variable Covariate Bedsc
NT with ICUd Teaching hospitald
Posterior Mean of the Incidence Rate Ratio (95% Posterior Credible Interval) HABSI
CA-BSI
All Hospitalsa 1.01
(1.01–1.02) 1.58
(1.34–1.87) 2.42
(1.95–3.01)
<10 yb 1.02
(1.01–1.03) 1.78
(1.37–2.35) 2.20
(1.49–3.31)
All Hospitalsa 1.01
(1.00–1.02) 2.42
(1.71–3.56) 6.12
(4.01–9.47)
<10 yb 1.02
(1.01–1.03) 1.99
(1.1–3.66) 3.14
(1.54–6.66)
infection secondary to urinary tract infection. aModels fitted to data from the entire cohort. bModels fitted separately to data from hospitals that have participated in BACTOT for <10 years. cThe effect of 10 beds is estimated by transforming a hospital’s number of beds by dividing by 10. dNonteaching hospital with ICU incident. Rate ratio is relative to nonteaching hospitals without ICUs.
All Hospitalsa 1.03
(1.02–1.04) 0.89
(0.67–1.18) 1.23
(0.86–1.75) NCA-BSI
<10 yb 1.03
(1.02–1.05) 1.02
(0.63–1.69) 1.42
(0.69–2.98) BSI-UTI
All Hospitalsa 1.01
(1.00–1.01) 1.90
(1.54–2.35) 1.72
(1.32–2.23)
<10 yb 1.00
(0.99–1.01) 2.14
(1.49–3.11) 1.75
(1.07–2.87) Note. HABSI, healthcare-associated bloodstream infection; CS-BSI, catheter-associated bloodstream infection; NCA-BSI, non–catheter-associated bloodstream infection; BSI-UTI, bloodstream
Table 3. Posterior Summary of the Incidence Rate Ratios of Year of Entry, Relative to 2014–2015, for Healthcare-Associated Bloodstream Infections and the Most Common Subtypes from Models Fitted for the Cohort and for Hospitals that Participated for <10 Years
Variable Infection Hospitals 2013–2014
2012–2013 2011–2012 2009–2010 2008–2009 2007–2008
Posterior Mean of the Incidence Rate Ratio (95% Posterior Credible Interval)
HABSI
All Hospitalsa 0.81
(0.60–1.03) 0.92
(0.69–1.19) 0.84
(0.60–1.08) 0.79
(0.58–1.01) 0.72
(0.53–0.94) 0.98
(0.79–1.18)
<10 yb 0.78
(0.58–0.99) 0.97
(0.74–1.28) 0.78
(0.56–1.01) 0.74
(0.54–0.96) 0.69
(0.51–0.92) CA-BSI
All Hospitalsa 0.68
(0.35–1.04) 0.78
(0.45–1.17) 0.78
(0.42–1.14) 0.84
(0.51–1.20) 0.82
(0.49–1.17) 1.17
(0.83–1.61)
infection secondary to urinary tract infection. aModels fitted to data from the entire cohort. bModels fitted separately to data from hospitals that have participated in BACTOT for <10 years.
<10 yb 0.79
(0.43–1.04) 0.89
(0.57–1.14) 0.83
(0.46–1.07) 0.89
(0.58–1.13) 0.86
(0.53–1.08) NCA-BSI
All Hospitalsa 0.99
(0.74–1.32) 1.18
(0.91–2.02) 0.97
(0.68–1.29) 0.95
(0.66–1.24) 0.86
(0.57–1.12) 0.96
(0.75–1.21)
<10 yb 0.99
(0.73–1.36) 1.20
(0.90–2.29) 0.96
(0.65–1.30) 0.96
(0.66–1.28) 0.87
(0.56–1.12) BSI-UTI
All Hospitalsa 0.82
(0.59–1.07) 1.11
(0.85–1.54) 0.88
(0.63–1.17) 0.78
(0.56–1.03) 0.65
(0.45–0.92) 0.93
(0.73–1.14) Note. HABSI, healthcare-associated bloodstream infection; CS-BSI, catheter-associated bloodstream infection; NCA-BSI, non–catheter-associated bloodstream infection; BSI-UTI, bloodstream
<10 yb 0.76
(0.56–1.01) 1.31
(0.93–1.88) 0.88
(0.64–1.19) 0.70
(0.51–0.95) 0.61
(0.45–0.83)
posterior rates of years 2 to 10 compared to year 1 (Table 4). This remained the case when only hospitals that participated in BACTOT for <10 years were analyzed separately. As for NCA- BSI, the posterior means of the rate ratios increased from the sev- enth year of surveillance until the tenth, when the rate was 29% (95% CI, 1%–89%) higher than the first year rate. However, in the subgroup analysis, both the posterior means and the credible intervals remained relatively constant. The variance of the pos- teriormean rates for all the models was consistently very low, high- lighting that the year-to-year changes in rates were largely similar across hospitals.
Period effect
We detected little difference in estimated posterior rates across periods within a surveillance year (Supplementary Figure 2 online). The fifth and sixth periods, which overlap with the months of
August and September, were associated with higher HABSI rates than the first periods in April; these were 8% (95% CI, 1%–16%) and 7% (95% CI, 0–14%) higher, respectively. CA-BSI rates also tended to be 15% (95% CI, 1%–33%) higher in the sixth periods compared to the first periods. No difference in NCABSI or BSI-UTI rates across periods was detected.
Discussion
Our study provides novel information regarding HABSI rates over years of surveillance, taking into account period and hospital effects. Contrary to our hypothesis, and despite the dedicated long-term surveillance, we detected no sustained change in rates of HABSI or of its most common subtypes. This remained the case when the 40 hospitals that entered the program at its inception were removed from the analyses. Cohort NCA-BSI rates increased in the seventh year to reach rates only slightly higher than the
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