OBJECTIVE To evaluate the impact of different surveillance standards and reporting entities on the determination of hospital-acquired pneumonia infection cases, and to provide a basis for optimizing the surveillance system.

METHODS The patients who were discharged from 4 tertiary hospitals in Jan. 2025 were recruited as the research subjects, and the early warning information was collected from the health care-associated infections surveillance system. An expert panel then re-evaluated the warning cases based on three surveillance criteria for hospital-associated pneumonia: the U.S. Centers for Disease Control and Prevention (2024 version), the World Health Organization (WHO), and the Chinese criteria (2009 version).

RESULTS With the expert panel′s judgment as the gold standard, among 92 cases of hospital-acquired pneumonia (HAP), the underreporting rate of the surveillance system reached 50.00%. Both the infection rate (0.22%) and the positive rate of early warning (1.34%) reported by the system were lower than the actual determined values (0.44%, 2.69%), with statistically significant differences (P < 0.05). The actual reporting rate of clinicians (76.09%) was higher than that of hospital-associated infection specialists, but their false reporting rate (20.43%) was also higher. Conversely, the non-reporting rate of specialists (51.09%) was particularly prominent. There were significant differences in the determination of the three surveillance standards themselves, with the CDC standard being the strictest and the WHO standard being the most lenient, and the consistency among standards was poor (Kappa < 0.2).

CONCLUSIONS To achieve precise and homogenous surveillance of hospital-acquired pneumonia, it is essential to first unify standards and standardize interpretation processes. It is recommended to systematically address this issue by developing structured guidelines, constructing intelligent information systems, and establishing multidisciplinary review mechanisms.