Table 1.
Characteristics, Validity, and Reliability of All Included Studies
| HAI | First Author. Year | Country | SS (N) | Study Design | Sensitivity | Specificity | LHR+ | LHR− | DOR | Kappa |
|---|---|---|---|---|---|---|---|---|---|---|
| Prosth. SSI | Curtis M. 2004 | Australia | 380 | Retrospective cohort | 0.60 (0.39–0.79) | 0.99 (0.97–1.00) | 53.25 (19.09–148.51) | 0.41 (0.25–0.65) | 131.63 (36.98–468.45) | 0.66 (0.56–0.76) |
| Bolon MK. 2009 | USA | 2,128 | Retrospective cohort | 0.89 (0.75–0.96) | 0.98 (0.98–0.99) | 48.61 (34.87–67.77) | 0.12 (0.05–0.26) | 419.97 (156.87–1,124.3) | 0.64 (0.60–0.68) | |
| Bolon MK. 2009 | USA | 4,194 | Retrospective cohort | 0.81 (0.70–0.89) | 0.99 (0.98–0.99) | 65.00 (48.44–87.22) | 0.20 (0.13–0.31) | 329.53 (175.87–617.47) | 0.64 (0.61–0.67) | |
| Inacio MCS. 2011 | USA | 42,173 | Retrospective cohort | 0.97 (0.95–0.98) | 0.92 (0.91–0.92) | 11.71 (11.29–12.14) | 0.04 (0.02–0.06) | 322.33 (192.42–539.94) | 0.19 (0.18–0.20) | |
| Calderwood MS. 2012 | USA | 576 | Retrospective cohort | 1.00 (0.29–1.00) | 0.93 (0.91–0.95) | 12.72 (7.89–20.49) | 0.13 (0.01–1.80) | 94.72 (4.81–1,866.3) | 0.12 (0.08–0.16) | |
| Calderwood MS. 2012 | USA | 724 | Retrospective cohort | 1.00 (0.40–1.00) | 0.96 (0.94–0.97) | 21.28 (13.51–33.50) | 0.10 (0.01–1.45) | 203.75 (10.73–3,870.3) | 0.20 (0.16–0.24) | |
| Grammatico‐Guillon L. 2014 | France | 1,010 | Case–control | 0.98 (0.96–0.99) | 0.71 (0.67–0.74) | 3.35 (2.97–3.77) | 0.03 (0.01–0.06) | 133.54 (58.56–304.49) | 0.60 (0.54–0.66) | |
| Non‐Prosth. SSI | Hirschhorn LR. 1993 | USA | 2,197 | Retrospective cohort | 0.65 (0.58–0.72) | 0.98 (0.97–0.98) | 26.95 (20.03–36.26) | 0.36 (0.30–0.43) | 75.30 (50.29–112.73) | 0.66 (0.62–0.70) |
| Baker C. 1995 | USA | 145 | Retrospective | 0.89 (0.52–1.00) | 0.88 (0.81–0.93) | 7.11 (4.31–11.74) | 0.13 (0.02–0.81) | 56.00 (6.59–476.00) | 0.42 (0.28–0.56) | |
| Hebden J. 2000 | USA | 423 | Cross‐sectional | 1.00 (0.75–1.00) | 0.98 (0.96–0.99) | 46.63 (23.79–91.38) | 0.04 (0.01–0.56) | 1,278.5 (70.12–23,312.4) | 0.76 (0.67–0.85) | |
| Cadwallader HL. 2001 | Australia | 510 | Retrospective cohort | 0.81 (0.58–0.95) | 0.99 (0.98–1.00) | 79.17 (32.31–194.03) | 0.19 (0.08–0.47) | 411.40 (101.36–1,669.8) | 0.78 (0.69–0.87) | |
| Romano PS. 2002 | USA | 991 | Cross‐sectional | 0.63 (0.24–0.91) | 0.99 (0.99–1.00) | 307.19 (69.59–1,356.1) | 0.38 (0.15–0.92) | 817.50 (111.37–6,000.5) | 0.66 (0.60–0.72) | |
| Stevenson KB. 2008 | USA | 3,882 | Retrospective cohort | 0.65 (0.57–0.73) | 0.90 (0.89–0.91) | 6.72 (5.76–7.84) | 0.39 (0.31–0.48) | 17.48 (12.20–25.05) | 0.27 (0.24–0.30) | |
| Olsen MA. 2010 | USA | 1,200 | Nested case–control | 0.88 (0.77–0.94) | 0.99 (0.99–1.00) | 124.25 (61.91–249.38) | 0.13 (0.07–0.24) | 987.00 (357.31–2,726.4) | 0.87 (0.81–0.93) | |
| Verelst S. 2010 | Belgium | 763 | Retrospective cohort | 0.79 (0.70–0.86) | 0.95 (0.93–0.96) | 15.65 (11.07–22.12) | 0.22 (0.15–0.32) | 71.07 (39.88–126.64) | 0.71 (0.64–0.78) | |
| Gerbier S. 2011 | France | 446 | Cross‐sectional | 0.79 (0.63–0.90) | 0.66 (0.61–0.70) | 2.30 (1.86–2.84) | 0.32 (0.17–0.60) | 7.18 (3.21–16.08) | 0.17 (0.11–0.24) | |
| Hollenbeak CS. 2011 | USA | 1,066 | Retrospective cohort | 0.20 (0.13–0.30) | 0.96 (0.94–0.97) | 4.57 (2.78–7.51) | 0.84 (0.75–0.93) | 5.47 (3.04–9.86) | 0.19 (0.13–0.25) | |
| Calderwood MS. 2012 | USA | 366 | Retrospective cohort | 1.00 (0.79–1.00) | 0.89 (0.85–0.92) | 8.85 (6.49–12.06) | 0.03 (0.01–0.51) | 267.86 (15.75–4,554.2) | 0.42 (0.34–0.50) | |
| Gerbier‐Colomban S. 2012 | France | 446 | Retrospective cohort | 0.79 (0.63–0.90) | 0.66 (0.61–0.70) | 2.30 (1.86–2.84) | 0.32 (0.17–0.60) | 7.18 (3.21–16.08) | 0.17 (0.11–0.23) | |
| Yokoe DS. 2012 | USA | 3,332 | Retrospective | 0.72 (0.67–0.77) | 0.81 (0.80–0.83) | 3.85 (3.49–4.26) | 0.34 (0.29–0.41) | 11.21 (8.71–14.42) | 0.34 (0.31–0.37) | |
| Knepper BC. 2013 | USA | 2,449 | Cross‐sectional | 0.66 (0.54–0.77) | 0.96 (0.95–0.96) | 15.15 (11.76–19.52) | 0.35 (0.25–0.49) | 42.84 (24.98–73.47) | 0.39 (0.35–0.43) | |
| Leclère B. 2014 | France | 4,400 | Cross‐sectional | 0.25 (0.17–0.34) | 0.98 (0.98–0.98) | 12.47 (8.50–18.28) | 0.77 (0.69–0.85) | 16.28 (10.10–26.27) | 0.23 (0.20–0.26) | |
| CDI | Dubberke ER. 2006 | USA | 3,630 | Retrospective cohort | 0.76 (0.73–0.80) | 0.92 (0.91–0.93) | 9.49 (8.35–10.80) | 0.26 (0.22–0.29) | 37.04 (29.64–46.29) | 0.65 (0.62–0.68) |
| Scheurer DB. 2007 | USA | 3,003 | Retrospective cohort | 0.71 (0.65–0.75) | 0.99 (0.98–0.99) | 53.92 (38.52–75.49) | 0.30 (0.25–0.35) | 181.05 (120.27–272.54) | 0.76 (0.72–0.80) | |
| Schmiedeskamp M. 2009 | USA | 23,920 | Retrospective cohort | 0.97 (0.89–1.00) | 1.00 (1.00–1.00) | 265.38 (214.13–328.91) | 0.03 (0.01–0.13) | 8,196.9 (1,972.5–34,063.1) | 0.57 (0.56–0.58) | |
| Chan M. 2011 | Singapore | 2,212 | Cross‐sectional | 0.50 (0.43–0.56) | 1.00 (0.99–1.00) | 120.59 (59.77–243.32) | 0.51 (0.45–0.57) | 238.41 (114.38–496.97) | 0.62 (0.58–0.66) | |
| Shaklee J. 2011 | USA | 27,122 | Retrospective cohort | 0.81 (0.72–0.88) | 1.00 (1.00–1.00) | 703.51 (489.07–1,012.0) | 0.19 (0.13–0.28) | 3,647.3 (2,017.5–6,593.9) | 0.77 (0.76–0.78) | |
| Jones G. 2012 | France | 31,7033 | Retrospective cohort | 0.36 (0.32–0.40) | 1.00 (1.00–1.00) | 1,909.2 (1,448.9–2,515.7) | 0.64 (0.61–0.68) | 2,964.1 (2,189.9–4,012.0) | 0.49 (0.45–0.53) | |
| Welker JA. 2012 | USA | 23,495 | Retrospective cohort | 0.87 (0.83–0.90) | 1.00 (0.99–1.00) | 179.48 (148.61–216.77) | 0.13 (0.10–0.17) | 1,371.7 (966.23–1,947.4) | 0.80 (0.79–0.81) | |
| Pakyz AL. 2015 | USA | 353 | Retrospective cohort | 0.68 (0.60–0.75) | 0.93 (0.89–0.96) | 10.19 (6.06–17.12) | 0.35 (0.27–0.44) | 29.37 (15.39–56.03) | 0.63 (0.55–0.72) | |
| Non‐VA Nos. Pneu.—VA Event | Romano PS. 2002 | USA | 991 | Retrospective cohort | 1.00 (0.03–1.00) | 1.00 (0.99–1.00) | 212.36 (56.91–792.39) | 0.25 (0.02–2.77) | 846.43 (29.16–24,571.0) | 0.40 (0.35–0.45) |
| Azaouagh A. 2008 | Germany | 130 | Retrospective cohort | 0.43 (0.24–0.63) | 0.99 (0.95–1.00) | 43.714 (5.94–321.94) | 0.58 (0.42–0.80) | 75.750 (9.21–622.97) | 0.52 (0.33–0.71) | |
| Stausberg J. 2008 | Germany | 23,356 | Retrospective cohort | 0.43 (0.37–0.49) | 1.00 (1.00–1.00) | 125.03 (96.88–161.37) | 0.57 (0.52–0.63) | 218.06 (159.01–299.03) | 0.50 (0.49–0.51) | |
| Gerbier S. 2011 | France | 1,499 | Cross‐sectional | 0.40 (0.33–0.48) | 0.92 (0.90–0.93) | 4.73 (3.65–6.13) | 0.65 (0.57–0.74) | 7.25 (5.00–10.49) | 0.30 (0.25–0.35) | |
| VAP/VAE | Stevenson KB. 2008 | USA | 193 | Retrospective cohort | 0.58 (0.37–0.78) | 0.84 (0.78–0.89) | 3.65 (2.25–5.92) | 0.50 (0.31–0.80) | 7.36 (2.96–18.29) | 0.32 (0.19–0.45) |
| Verelst S. 2010 | Belgium | 763 | Cross‐sectional | 0.72 (0.53–0.87) | 0.92 (0.90–0.94) | 9.16 (6.563–12.80) | 0.30 (0.17–0.54) | 30.60 (12.98–72.11) | 0.35 (0.29–0.41) | |
| Cass AL. 2013 | USA | 6,104 | Retrospective cohort | 0.61 (0.41–0.78) | 0.93 (0.93–0.94) | 9.00 (6.58–12.30) | 0.42 (0.27–0.67) | 21.36 (9.94–45.90) | 0.07 (0.06–0.08) | |
| CAUTI | Romano PS. 2002 | USA | 991 | Retrospective cohort | 0.50 (0.32–0.68) | 0.99 (0.99–1.00) | 95.70 (37.51–244.16) | 0.50 (0.36–0.70) | 190.40 (62.97–575.70) | 0.60 (0.45–0.75) |
| Zhan C. 2009 | USA | 17,059 | Retrospective cohort | 0.68 (0.64–0.72) | 0.91 (0.91–0.92) | 7.76 (7.195–8.36) | 0.35 (0.31–0.39) | 22.44 (18.59–27.08) | 0.28 (0.27–0.29) | |
| Gerbier S. 2011 | France | 1,499 | Cross‐sectional | 0.00 (0.00–0.03) | 1.00 (0.99–1.00) | 0.83 (0.05–14.56) | 1.00 (0.99–1.01) | 0.82 (0.05–14.72 | –0.01 (–0.03;0.01) | |
| Cass AL. 2013 | USA | 6,283 | Retrospective cohort | 0.70 (0.50–0.86) | 0.95 (0.94–0.95) | 13.84 (10.60–18.08) | 0.31 (0.18–0.56) | 44.34 (19.27–102.08) | 0.10 (0.09–0.11) | |
| Gardner A. 2014 | Australia | 1,109 | Retrospective cohort | 0.60 (0.26–0.88) | 0.93 (0.91–0.94) | 8.24 (4.76–14.26) | 0.43 (0.20–0.92) | 19.11 (5.28–69.09) | 0.11 (0.08–0.14) | |
| CLABSI | Stevenson KB. 2008 | USA | 1,599 | Retrospective cohort | 0.48 (0.40–0.56) | 0.66 (0.63–0.68) | 1.41 (1.19–1.67) | 0.79 (0.68–0.91) | 1.79 (1.31–2.45) | 0.07 (0.03–0.11) |
| Cass AL. 2013 | USA | 28,761 | Retrospective cohort | 0.62 (0.51–0.72) | 0.99 (0.99–0.99) | 63.01 (51.59–76.96) | 0.39 (0.30–0.50) | 162.23 (104.65–251.50) | 0.26 (0.25–0.27) | |
| Patrick SW. 2013 | USA | 2,920 | Retrospective cohort | 0.07 (0.01–0.18) | 1.00 (0.99–1.00) | 27.37 (7.31–102.47) | 0.94 (0.87–1.01) | 29.26 (7.31–117.03) | 0.10 (0.07–0.13) | |
| MRSA | Schaefer MK. 2010a | USA | 22,172 | Retrospective cohort | 0.59 (0.54–0.64) | 1.00 (1.00–1.00) | 753.07 (464.98–1,219.6) | 0.41 (0.37–0.46) | 1,826.8 (1,091.2–3,058.2) | 0.72 (0.70–0.73) |
| Schweizer ML. 2011a | USA | 46,6819 | Retrospective cohort | 0.24 (0.23–0.25) | 0.99 (0.99–0.99) | 35.47 (33.48–37.58) | 0.77 (0.75–0.78) | 46.36 (43.23–49.72) | 0.26 (0.25–0.27) | |
| NARGE | Redondo‐González O. 2015a | Spain | 9,602 | Cross‐sectional | 0.67 (0.52–0.80) | 1.00 (1.00–1.00) | 201.05 (135.17–299.05) | 0.33 (0.22–0.49) | 613.66 (307.60–1,224.23) | 0.58 (0.46–0.70) |
| Nos. Bact. | Gerbier S. 2011a | France | 1,498 | Cross‐sectional | 0.59 (0.44–0.73) | 0.84 (0.82–0.86) | 3.76 (2.90–4.88) | 0.48 (0.34–0.68) | 7.77 (4.32–13.97) | 0.14 (0.04–0.24) |
| NOI | Gerbier S. 2011a | France | 902 | Cross‐sectional | 0.43 (0.24–0.63) | 0.85 (0.83–0.88) | 2.95 (1.87–4.66) | 0.67 (0.48–0.93) | 4.41 (2.04–9.54) | 0.10 (–0.04;0.23) |
| NIA | Chang DC. 2008a | USA | 1,736 | Cross‐sectional | 0.84 (0.60–0.97) | 0.97 (0.96–0.98) | 30.12 (21.44–42.33) | 0.16 (0.06–0.46) | 185.44 (52.28–657.76) | 0.37 (0.21–0.54) |
| DRM | Van Mourik MSM. 2013a | Netherl. | 617 | Cross‐sectional | 0.32 (0.23–0.42) | 0.89 (0.86–0.91) | 2.87 (1.96–4.18) | 0.77 (0.66–0.89) | 3.74 (2.25–6.21) | 0.22 (0.09–0.34) |
| PO Sepsis | Verelst S. 2010a | Belgium | 763 | Cross‐sectional | 0.69 (0.50–0.84) | 0.95 (0.93–0.96) | 13.58 (9.18–20.09) | 0.33 (0.20–0.55) | 41.26 (18.22–93.45) | 0.45 (0.30–0.61) |
a
Non‐meta‐analyzable studies.
CAUTI, catheter‐associated urinary tract infection; CDI, Clostridium difficile infection; CLABSI, central line‐associated bloodstream infection; DOR, diagnostic odds ratio; DRM, drain‐related meningitis; HAI, hospital‐associated infections; LHR, likelihood ratio; MRSA, methicillin‐resistant Staphylococcus aureus; NARGE, nosocomial acute rotavirus gastroenteritis; Nos. Bact., nosocomial bacteremia; Nos. Pneu., nosocomial pneumonia; NIA, nosocomial invasive aspergillosis; Netherl., Netherlands; NOI, nosocomial obstetric infection; PO Sepsis, postoperative sepsis; Prosth. SSI, prosthetic surgical site infection; SS, sample size; VA, ventilator‐associated; VAE, ventilator‐associated event; VAP, ventilator‐associated pneumonia.