{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:23:00Z","timestamp":1788967380075,"version":"build-2803163510"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Hospital-onset bacteremia and fungemia (HOB) is being proposed as a new hospital quality metric for health care\u2013associated infections. There is a lack of data on the ability of HOB to discriminate between hospitals from a large regional perspective.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe and compare the HOB rates across hospitals for the province of Ontario in Canada.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based retrospective cohort study used ICES Ontario databases. Participants were adult patients admitted to an acute care hospital from 2017 to 2024 in Ontario, Canada.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Local care processes and practices in different hospitals.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n HOB was defined as a positive blood culture collected on or after hospital day 4. HOB rates per admission-days were described across hospital sites. A generalized linear mixed-effects model was used to compare variation in HOB rates across hospitals while adjusting for patient and hospital characteristics.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n At 114 acute-care hospitals in Ontario, Canada, there were 3\u202f325\u202f900 hospital admissions (median [IQR] age, 71 [57-81] years; 1\u202f727\u202f228 female patients [51.9%]). In total, there were 61\u202f452 HOB episodes observed over 29\u202f721\u202f745 admission-days, equal to an overall rate of 2.07 episodes per 1000 admission-days. Across the 114 acute-care hospitals, the HOB rates were 0.39 episodes per 1000 admission-days for the 10th percentile, 0.71 episodes per 1000 admission-days for the 25th percentile, 1.08 episodes per 1000 admission-days for the 50th percentile, 1.68 episodes per 1000 admission-days for the 75th percentile, and 2.27 episodes per 1000 admission-days for the 90th percentile. In a generalized linear mixed-effects model, the random intercept for hospital sites had an SD of 0.36 (95% CI, 0.29-0.42), which corresponded to a rate ratio of 1.43 (95% CI, 1.34-1.52) per 1 SD.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of 114 hospitals, there was significant variability in hospital HOB rates, suggesting that HOB may be a useful quality metric in discriminating between hospitals.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.32981","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:00:39Z","timestamp":1788966039000},"page":"e2632981","source":"Crossref","is-referenced-by-count":0,"title":["Variability in Hospital-Onset Bacteremia in Ontario"],"prefix":"10.1001","volume":"9","author":[{"given":"Olivier","family":"Bedard-Lapointe","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejiao Shelly","family":"Wei","sequence":"additional","affiliation":[{"name":"ICES Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute, Toronto, Ontario, Canada"},{"name":"Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Brown","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fizza","family":"Manzoor","sequence":"additional","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts"},{"name":"Division of Infectious Diseases, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Golmohammadzadeh","sequence":"additional","affiliation":[{"name":"School of Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Mertz","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada"},{"name":"Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Chagla","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada"},{"name":"St Joseph Healthcare Hamilton, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Flemming","sequence":"additional","affiliation":[{"name":"ICES Queen\u2019s University, Kingston, Ontario, Canada"},{"name":"Division of Gastroenterology, Department of Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudeep S.","family":"Gill","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine, Department of Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony D.","family":"Bai","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"6","key":"zoi260899r1","doi-asserted-by":"publisher","first-page":"822","DOI":"10.7326\/M24-0546","article-title":"Moving beyond central line-associated bloodstream infections.","volume":"177","author":"Howard-Anderson","year":"2024","journal-title":"Ann Intern Med"},{"issue":"2","key":"zoi260899r2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1017\/ice.2015.261","article-title":"A multicenter longitudinal study of hospital-onset bacteremia: time for a new quality outcome measure?","volume":"37","author":"Rock","year":"2016","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"1","key":"zoi260899r3","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2023.486","article-title":"Hospital-onset bacteremia and fungemia: examining healthcare-associated infections prevention through a wider lens.","volume":"3","author":"Schrank","year":"2023","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"issue":"8","key":"zoi260899r4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1136\/bmjqs-2023-016831","article-title":"Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study.","volume":"33","author":"Leekha","year":"2024","journal-title":"BMJ Qual Saf"},{"issue":"3","key":"zoi260899r6","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1017\/ice.2018.339","article-title":"Preventability of hospital onset bacteremia and fungemia: a pilot study of a potential healthcare-associated infection outcome measure.","volume":"40","author":"Dantes","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"1","key":"zoi260899r7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1017\/ice.2023.139","article-title":"Healthcare-associated infections and conditions in the era of digital measurement.","volume":"45","author":"Classen","year":"2024","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"10","key":"zoi260899r9","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1017\/ice.2022.211","article-title":"Hospital-onset bacteremia and fungemia: an evaluation of predictors and feasibility of benchmarking comparing two risk-adjusted models among 267 hospitals.","volume":"43","author":"Yu","year":"2022","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"8","key":"zoi260899r10","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"4","key":"zoi260899r11","doi-asserted-by":"publisher","first-page":"E1044","DOI":"10.9778\/cmajo.20210215","article-title":"Antibiotic susceptibility of urine culture specimens in Ontario: a population-based cohort study.","volume":"10","author":"Marchand-Austin","year":"2022","journal-title":"CMAJ Open"},{"issue":"4","key":"zoi260899r13","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1128\/CMR.00062-05","article-title":"Updated review of blood culture contamination.","volume":"19","author":"Hall","year":"2006","journal-title":"Clin Microbiol Rev"},{"issue":"5","key":"zoi260899r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.106283","article-title":"Long-term morbidity and mortality of patients who survived past 30 days from bloodstream infection: a population-based retrospective cohort study.","volume":"89","author":"Bai","year":"2024","journal-title":"J Infect"},{"issue":"2","key":"zoi260899r15","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1001\/jama.2017.20040","article-title":"Association between handover of anesthesia care and adverse postoperative outcomes among patients undergoing major surgery.","volume":"319","author":"Jones","year":"2018","journal-title":"JAMA"},{"key":"zoi260899r5","unstructured":"Centers for Medicare & Medicaid Services. List of measures under consideration for December 1, 2021. 2021. Accessed March 8, 2026. https:\/\/www.cms.gov\/files\/document\/measures-under-consideration-list-2021-report.pdf"},{"key":"zoi260899r8","unstructured":"National Quality Forum (NQF). Hospital onset-bacteremia and fungemia playbook. 2024. Accessed July 28, 2026. https:\/\/www.qualityforum.org\/en-us\/key-initiatives\/hospital-onset-bacteremia-and-fungemia-prevention-and-care-implementation-guide"},{"key":"zoi260899r12","unstructured":"Ontario Ministry of Health. Ontario\u2019s public hospitals. July 18, 2023. Accessed June 28, 2026. https:\/\/www.ontario.ca\/page\/ontarios-public-hospitals"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2853851\/bedardlapointe_2026_oi_260899_1788273404.16039.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:00:41Z","timestamp":1788966041000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2853851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":15,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.32981","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}