Boggan Joel C, Baker Arthur W, Lewis Sarah S, Dicks Kristen V, Durkin Michael J, Moehring Rebekah W, Chen Luke F, Knelson Lauren P, Hegland Donald D, Anderson Deverick J
Division of Hospital Medicine ; Department of Medicine, Durham Veterans Affairs Medical Center ; Division of General Internal Medicine, Department of Medicine.
Duke Infection Control Outreach Network ; Duke Program for Infection Prevention and Healthcare Epidemiology ; Divisions of Infectious Diseases.
Open Forum Infect Dis. 2015 Sep 1;2(4):ofv128. doi: 10.1093/ofid/ofv128. eCollection 2015 Dec.
Background. The optimum approach for infectious complication surveillance for cardiac implantable electronic device (CIED) procedures is unclear. We created an automated surveillance tool for infectious complications after CIED procedures. Methods. Adults having CIED procedures between January 1, 2005 and December 31, 2011 at Duke University Hospital were identified retrospectively using International Classification of Diseases, 9th revision (ICD-9) procedure codes. Potential infections were identified with combinations of ICD-9 diagnosis codes and microbiology data for 365 days postprocedure. All microbiology-identified and a subset of ICD-9 code-identified possible cases, as well as a subset of procedures without microbiology or ICD-9 codes, were reviewed. Test performance characteristics for specific queries were calculated. Results. Overall, 6097 patients had 7137 procedures. Of these, 1686 procedures with potential infectious complications were identified: 174 by both ICD-9 code and microbiology, 14 only by microbiology, and 1498 only by ICD-9 criteria. We reviewed 558 potential cases, including all 188 microbiology-identified cases, 250 randomly selected ICD-9 cases, and 120 with neither. Overall, 65 unique infections were identified, including 5 of 250 reviewed cases identified only by ICD-9 codes. Queries that included microbiology data and ICD-9 code 996.61 had good overall test performance, with sensitivities of approximately 90% and specificities of approximately 80%. Queries with ICD-9 codes alone had poor specificity. Extrapolation of reviewed infectious rates to nonreviewed cases yields an estimated rate of infection of 1.3%. Conclusions. Electronic queries with combinations of ICD-9 codes and microbiologic data can be created and have good test performance characteristics for identifying likely infectious complications of CIED procedures.
背景。心脏植入式电子设备（CIED）手术感染并发症的最佳监测方法尚不清楚。我们创建了一种用于CIED手术后感染并发症的自动监测工具。方法。使用国际疾病分类第9版（ICD-9）手术编码，对2005年1月1日至2011年12月31日在杜克大学医院接受CIED手术的成年人进行回顾性识别。通过ICD-9诊断编码和术后365天的微生物学数据组合来识别潜在感染。对所有微生物学确诊的病例、ICD-9编码确诊的部分可能病例以及没有微生物学或ICD-9编码的部分手术病例进行了审查。计算了特定查询的测试性能特征。结果。总体而言，6097例患者接受了7137次手术。其中，识别出1686例有潜在感染并发症的手术：174例通过ICD-9编码和微生物学确诊，14例仅通过微生物学确诊，1498例仅通过ICD-9标准确诊。我们审查了558例潜在病例，包括所有188例微生物学确诊病例、250例随机选择的ICD-9病例以及120例两者均无的病例。总体而言，识别出65例独特感染，包括250例审查病例中的5例仅通过ICD-9编码确诊。包含微生物学数据和ICD-9编码996.61的查询总体测试性能良好，敏感性约为90%，特异性约为80%。仅使用ICD-9编码的查询特异性较差。将审查的感染率外推至未审查病例得出估计感染率为1.3%。结论。可以创建结合ICD-9编码和微生物学数据的电子查询，并且在识别CIED手术可能的感染并发症方面具有良好的测试性能特征。
