Conventional manual surveillance of healthcare-associated infections is labour-intensive and therefore often restricted to areas with high-risk patients. Fully automated surveillance of hospital-onset bacteraemia and fungaemia (HOB) may facilitate hospital-wide surveillance.

To develop an algorithm and minimal dataset (MDS) required for automated surveillance of HOB and apply it to real-life routine data in four European hospitals

Through consensus discussion, a HOB definition with MDS suitable for automated surveillance was developed and applied in a retrospective multicentre observational study including all adult patients admitted to hospitals in the Netherlands, Germany, Sweden and Switzerland (2018–22). Annual HOB rates were calculated per 1,000 patient days for hospital, intensive care unit (ICU) and non-ICU settings.

HOB was defined as a positive blood culture with a recognised pathogen 2 or more days after hospital admission. For common commensals, two blood cultures with the same commensal within 2 days were required. HOB rates were comparable between the four hospitals (1.0–2.2/1,000 patient days). HOB rates were substantially higher in ICU than non-ICU settings, and HOB with common commensals accounted for 14.8–28.2% of all HOB. HOB rates per 1,000 patient days were consistent over time, but higher in 2020–21. HOB caused by Staphylococcus aureus comprised 8.4–16.0% of all HOB.

Automated HOB surveillance using a common definition was feasible and reproducible across four European hospitals. Future studies should investigate clinical relevance and preventability of HOB, and focus on strategies to make the automated HOB metric an actionable infection control tool.

HIV testing guided by indicator condition (IC) is recommended by the World Health Organization to facilitate earlier diagnosis. However, it is unclear to what extent these guidelines are followed in routine primary care (PC).

To estimate the prevalence and distribution of ICs in PC in Catalonia, Spain, identify factors associated with, and prevalence of, an HIV test being administered, or not, within 4 months of IC diagnosis and assess trends over time.

A population-based cross-sectional study was conducted using data from the Information System for the Development of Research in Primary Care, covering 5.8 million individuals in Catalonia. We identified IC episodes recorded from 1 January 2017 to 31 August 2021 among patients aged 16–65 years. For each IC episode, we assessed whether an HIV test was performed within 4 months.

We identified 372,712 IC episodes; 84,694 (22.7%) led to an HIV test within 4 months. Testing was higher for: men (26.3% vs 19.4% for women); migrants (27.7% vs 21.3% for Spanish citizens); younger patients (29.2% for 16–30-year-olds vs 13.7% for those over 50 years). Testing rates were highest for episodes involving syphilis (68.4%), genital herpes (50.6%), chlamydia (48.2%) and gonorrhoea (43.1%). Factors associated with increased testing included male sex, higher socioeconomic deprivation area, presence of an acute sexually transmitted infection and multiple ICs.

Substantial gaps remain in HIV testing based on ICs in PC in Catalonia. Targeted interventions are needed to improve adherence to IC-guided testing, enabling early HIV diagnosis and treatment.