Automated Detection of Healthcare Associated Infections External Validation and Updating of a Model for Surveillance of Drain-Related Meningitis.docVIP

AutomatedDetectionofHealthcareAssociated Infections:ExternalValidationandUpdatingofaModel forSurveillanceofDrain-RelatedMeningitis MaaikeS.M.vanMourik1*,KarelG.M.Moons2,WouterW.vanSolinge3,Jan-WillemBerkelbach-vander Sprenkel4,LucaRegli4,AnnetTroelstra1,MarcJ.M.Bonten1,2 1Department ofMedicalMicrobiology, UniversityMedicalUtrecht, Utrecht,The Netherlands, 2JuliusCenterfor Health SciencesandPrimaryCare,UniversityMedical Utrecht, Utrecht, The Netherlands, 3Department of Clinical Chemistry and Hematology, University Medical Utrecht, Utrecht, The Netherlands, 4Department of Neurosurgery,RudolfMagnusInstituteofNeuroscience,UniversityMedicalUtrecht,Utrecht,TheNetherlands Abstract Objective:Automatedsurveillanceofhealthcare-associatedinfectionscanimproveefficiencyandreliabilityofsurveillance. The aim was to validate and update a previously developed multivariable prediction model for the detection of drain- relatedmeningitis(DRM). Design:Retrospectivecohortstudyusingtraditionalsurveillancebyinfectioncontrolprofessionalsasreferencestandard. Patients: Patients receiving an external cerebrospinal fluid drain, either ventricular (EVD) or lumbar (ELD) in a tertiary medical care center. Children, patients with simultaneous drains, ,1day of follow-up or pre-existing meningitis were excludedleaving105patientsinvalidationset(2010–2011)and653inupdatingset(2004–2011). Methods: For validation,theoriginalmodelwasapplied. Discrimination,classification andcalibration wereassessed. For updating,datafromallavailableyearswasusedtooptimallyre-estimatecoefficientsanddeterminewhetherextensionwith newpredictorsisnecessary.Theupdatedmodelwasvalidatedandadjustedforoptimism(overfitting)usingbootstrapping techniques. Results:Inmodelvalidation,therateofDRMwas17.4/1000daysatrisk.Allcasesweredetectedbythemodel.Thearea undertheROCcurvewas0.951.Thepositivepredictivevaluewas58.8%(95%CI40.7–75.4)andcalibrationwasgood.The revisedmodelalsoincludesGramstainresults.AreaundertheROCcurveaftercorrectionfor