Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Infect Control Hosp Epidemiol. 2011 Feb;32(2):148-54. doi: 10.1086/657936.
Investigators and medical decision makers frequently rely on administrative databases to assess methicillin-resistant Staphylococcus aureus (MRSA) infection rates and outcomes. The validity of this approach remains unclear. We sought to assess the validity of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for infection with drug-resistant microorganisms (V09) for identifying culture-proven MRSA infection.
Retrospective cohort study.
All adults admitted to 3 geographically distinct hospitals between January 1, 2001, and December 31, 2007, were assessed for presence of incident MRSA infection, defined as an MRSA-positive clinical culture obtained during the index hospitalization, and presence of the V09 ICD-9-CM code. The κ statistic was calculated to measure the agreement between presence of MRSA infection and assignment of the V09 code. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated.
There were 466,819 patients discharged during the study period. Of the 4,506 discharged patients (1.0%) who had the V09 code assigned, 31% had an incident MRSA infection, 20% had prior history of MRSA colonization or infection but did not have an incident MRSA infection, and 49% had no record of MRSA infection during the index hospitalization or the previous hospitalization. The V09 code identified MRSA infection with a sensitivity of 24% (range, 21%-34%) and positive predictive value of 31% (range, 22%-53%). The agreement between assignment of the V09 code and presence of MRSA infection had a κ coefficient of 0.26 (95% confidence interval, 0.25-0.27).
In its current state, the ICD-9-CM code V09 is not an accurate predictor of MRSA infection and should not be used to measure rates of MRSA infection.
调查人员和医疗决策制定者经常依赖于行政数据库来评估耐甲氧西林金黄色葡萄球菌（MRSA）感染率和结果。这种方法的有效性尚不清楚。我们试图评估国际疾病分类，第 9 版，临床修正版（ICD-9-CM）用于耐药微生物感染的代码（V09）识别培养阳性的 MRSA 感染的准确性。
回顾性队列研究。
所有 2001 年 1 月 1 日至 2007 年 12 月 31 日期间在 3 个地理位置不同的医院住院的成年人都被评估为是否存在新发 MRSA 感染，定义为在住院期间获得的 MRSA 阳性临床培养物，以及是否存在 V09 ICD-9-CM 代码。计算κ统计量以衡量 MRSA 感染的存在与 V09 代码分配之间的一致性。计算了灵敏度、特异性、阳性预测值和阴性预测值。
研究期间共有 466819 名患者出院。在被分配 V09 代码的 4506 名出院患者（1.0%）中，有 31%患有新发 MRSA 感染，20%有既往 MRSA 定植或感染史但无新发 MRSA 感染，49%在指数住院期间或前一次住院期间无 MRSA 感染记录。V09 代码识别 MRSA 感染的灵敏度为 24%（范围，21%-34%），阳性预测值为 31%（范围，22%-53%）。V09 代码分配与 MRSA 感染存在之间的一致性κ系数为 0.26（95%置信区间，0.25-0.27）。
在目前的状态下，ICD-9-CM 代码 V09 不是 MRSA 感染的准确预测指标，不应用于衡量 MRSA 感染率。
