Case validation of bloodstream infections with an antibiotic-resistant organism
Bibliographic record
Abstract
Background: Bloodstream infections (BSIs) are an important cause of morbidity and mortality in severely ill patients, contributing to increased length of hospital stay and higher cost of care. Alberta Health Services Infection Prevention and Control (IPC) conducts inpatient surveillance of new episodes of BSIs with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) or carbapenemase-producing organisms (CPO) in 112 acute care facilities. A case-finding process was undertaken to verify the accuracy of BSI data entry. Methods: All positive MRSA, VRE or CPO blood cultures in 2021 were linked to the Inpatient Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS) to identify new cases during acute care admissions. The results were then compared to surveillance records captured by infection control professionals (ICPs). Cases with unmatched culture date and/or encounter date and cases not identified by ICPs were screened by the study team with final decision made by ICPs. Results were analyzed by ARO and by % increase in number of surveillance records. Results: The laboratory linkage identified 286 new cases. Comparing to surveillance records (n = 248) captured by ICPs, 137 (57.3%) had matching collection dates and encounter dates, 85 (35.6%) had close matches on collection dates and encounter dates, 17 (7.1%) records had either matching collection dates or encounter dates, and 1 (0.4%) record did not have any matches on dates. There were 46 records identified in the laboratory data that were not in the surveillance system and 8 records that were in the surveillance system but not matched to the laboratory data. After review, 22 Surveillance records had data entry errors (1 CPO BSI, 20 MRSA BSI, and 1 VRE BSI), and there were 14 BSI records found to be missing (13 MRSA BSI, 1 VRE BSI). This represents a 6% increase in MRSA BSI and a 3% increase in VRE BSI identified in 2021 and no increase in CPO BSI. Conclusions: A laboratory validation to determine if BSIs with an ARO were missed during routine IPC surveillance identified a small proportion of missed bloodstream infections. The most common reason for the miss was admission through the emergency department with multiple blood cultures collected during a single admission. These results will be shared with the Infection Control program to facilitate correct BSI capture.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.030 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".