Data collection The OSI entered data from the patient records in a data registration form prepared in Excel. The following data were recorded for each included patient: gender, age, hospital and ICU admission data, ward type, ICU type, date of onset and type of limitation of treatment (such as withholding or withdrawal of life‐sustaining treatment), type of surgery for SSI cases, type of HAI, date of HAI and date of death, microbiology results (with a maximum of two pathogens), other HAI (BSI, pneumonia, CDI or SSI) and, in case of CDI, origin (healthcare‐ or community‐associated) and complicated course. If more than one HAI was present, the HAI considered as the most severe was selected for the review. The assessment of the contribution was performed with the help of a checklist to increase inter‐rater reliability and facilitate the interpretation of the results by the project group. This checklist included both objective and subjective items (for details see the data entry form (Supplementary Text Box S1)): expected mortality on admission when not admitted to an ICU, severity scores (Simplified Acute Physiology Score (SAPS) II or Acute Physiology and Chronic Health Evaluation (APACHE) II_III scores for ICUs, from which the expected mortality on admission was derived using ECDC HAI surveillance data from 2012 to 2015, and Sequential Organ Failure Assessment (SOFA) score), condition and comorbidities on hospital admission (McCabe score, Charlson’s severity of illness and Charlson’s comorbidities), American Society of Anesthesiologists (ASA) score for patients with a SSI, status of HAI on the day of death (HAI or complication thereof still active), severity of the HAI, plausible pathophysiological mechanism for contribution of the HAI to death, and presence of competing cause for the death. In addition, we recorded selected antimicrobial resistance (AMR) phenotypes under surveillance, as specified in HAI‐Net protocols (16), the perceived adequacy of antimicrobial treatment, and the contribution of AMR to the death of the patient, using scales similar to 3CAT and QUANT (Supplementary Table S1). Treatment was considered inadequate when the initiated empirical treatment, although conforming to the local antimicrobial policy, did not match the susceptibility of the cultured microorganisms, resulting in a delay in instituting adequate antimicrobial treatment. AMR could have contributed to death through a delay in adequate antimicrobial treatment or an adverse event (such as renal failure) induced by the antimicrobial prescribed to treat a HAI with a resistant organism. For each case, reviewers answered the question “How well did [the measure] apply” independently assessing the fit of the measure (with the categories: applies well/reasonably/poorly/not). The fit indicated how well the assigned category for each 6 109 Mortality review reproducibility study
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