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Supplementary electronic queries help identify infectious CIED complications
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Electronic queries that combined ICD-9 codes and microbiologic data detected more infectious complications after cardiac implantable electronic device placement than ICD-9 codes alone, according to recent findings.
“Given the increasing frequency of [cardiac implantable electronic device (CIED)] procedures, comprehensive infection control programs need additional strategies to monitor infectious complications other than reliance on provider recognition and reporting,” Deverick J. Anderson, MD, MPH, from the infectious diseases division at Duke University Medical Center, and colleagues wrote in Open Forum Infectious Diseases. “Our primary goal was to create a novel electronic tool that exhibited a high sensitivity for CIED infectious complications, as compared to expert chart reviews.”
Deverick J. Anderson
The study included 6,097 patients aged 18 years and older who underwent CIED placement from January 2005 through December 2011 at Duke University Hospital. The researchers used specific ICD-9 diagnosis codes to identify potential infection-related complications, including pocket infections, lead infections, endocarditis and bacteremia. Microbiology data on bacterial and fungal blood cultures; aerobic and anaerobic cultures from sources other than blood; acid-fast bacillus cultures; bacterial body fluid cultures; bacterial tissue cultures, fungal cultures from nonblood sources; and bacterial catheter tip cultures were assessed up to 1 year after the procedure.
Of 7,137 procedures, 1,686 had potential infectious complications. One hundred seventy-four were identified with ICD-9 coding and microbiology data, 14 with microbiology alone and 1,498 with ICD-9 coding alone.
The researchers performed a chart review of 558 possible cases, which included all cases that used microbiology data, along with random subsets of 250 patients with ICD-9 codes suggestive of infectious complication and 120 patients with neither positive cultures nor ICD-9 codes suggesting infection. Sixty-five of these cases with confirmed infectious complications were further reviewed.
The most common pathogens were coagulase-negative Staphylococci (42%), methicillin-sensitive Staphylococcus aureus (23%) and MRSA (11%). Sixty confirmed infections were detected by ICD-9 codes plus microbiologic data, and five were detected using only ICD-9 codes. When the researchers applied their findings to all 7,137 procedures, they estimated that ICD-9 codes alone would identify an additional 30 confirmed infectious complications for an estimated infection rate of 1.3%.
Queries that were based on microbiology data and ICD-9 code 996.61 performed well overall, with sensitivities of roughly 90% and specificities of roughly 80%. Queries that included ICD-9 codes alone demonstrated poor test specificity, according to the researchers.
“Combinations of both microbiology data and ICD-9 codes provided the best test performance characteristics,” the researchers wrote. “Future work on prospective validation of these queries and integration of these and similar strategies into broader surveillance efforts should improve patient safety after nontraditional procedures and inform future quality improvement and assessment practices.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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