that of 3CAT, both overall and for each type of HAI. Kappa differed significantly between hospitals (p<0.0001). Similar to 3CAT and WHOCAT, the ICC was highest for pneumonia and lowest for CDI. The observed agreement for QUANT (Figure 1) was higher at the extreme values of the scale than at the intermediate values. All three measures were reported to fit reasonably to well for more than 88% of the reviewed cases (Supplementary Table S2). WHOCAT and QUANT measures were considered to fit better than 3CAT. Pathogens, antimicrobial resistance and adequacy of treatment. Most recorded HAI were caused by Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa (see Supplemental Table S3 for isolates per type of HAI). The CDI ribotype was available in ca half (38/71) of the cases. In the three centres that recorded the majority of CDI cases, PCR ribotype 027 was the main type in two centres. In the third centre PCR ribotype 198, a 027‐related ribotype, predominated. Data on AMR were available in 79% (173/220) of the cases (cases without AMR data and CDI cases excluded) and the AMR phenotypes under surveillance were present in 56% (42/75) of BSI, 62% (50/81) of pneumonia and six of 17 of SSI cases. Almost all (23/25) A. baumannii isolates were carbapenem‐resistant. Carbapenem resistance was frequently present in P. aeruginosa (15/30) and K. pneumoniae (9/26) isolates. Among S. aureus isolates, five of 16 were oxacillin‐resistant. For microorganisms with the AMR phenotypes under surveillance, AMR contributed “possibly” or “definitely” to death in 70‐72% of cases (66/94 and 68/94, respectively, TP and OSI; “unknown” and “no antibiotics given” excluded). Overall, agreement on the contribution of AMR to death was good: wk = 0.83 (95% CI: 0.74‐0.92) for the 3CAT measure for AMR. In HAI cases by organisms with the AMR phenotypes under surveillance, the contribution of the HAI to death, using 3CAT, was classified as possible or definite in 86% of TP assessments and 95% of OSI assessments (“definitely” in 57% by TP and 47% by OSI, Supplementary Table S6A). This proportion with possible or definite contribution was slightly smaller in cases of HAI caused by organisms lacking these AMR phenotypes: 84% of TP assessments and 85% of OSI assessments (p=0.34 for TP, p=0.03 for OSI), and less frequently classed as definite (41% by TP and 35% by OSI, Supplementary Table S6B). 6 113 Mortality review reproducibility study
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