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An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures.

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Date
2015-12
Authors
Boggan, JC
Baker, AW
Lewis, SS
Dicks, KV
Durkin, MJ
Moehring, RW
Chen, LF
Knelson, LP
Hegland, DD
Anderson, DJ
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Abstract
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.
Type
Journal article
Subject
cardiac implantable
electronic devices infection control
electronic surveillance
Permalink
https://hdl.handle.net/10161/12047
Published Version (Please cite this version)
10.1093/ofid/ofv128
Publication Info
Boggan, JC; Baker, AW; Lewis, SS; Dicks, KV; Durkin, MJ; Moehring, RW; ... Anderson, DJ (2015). An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures. Open Forum Infect Dis, 2(4). pp. ofv128. 10.1093/ofid/ofv128. Retrieved from https://hdl.handle.net/10161/12047.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Anderson

Deverick John Anderson

Professor of Medicine
Hospital epidemiology, infection control, antibiotic stewardship, multidrug-resistant organisms, device-related infections, surgical site infections, catheter-associated bloodstream infections, cost of infections, infections in community hospitals
Baker

Arthur Wakefield Baker

Assistant Professor of Medicine
Boggan

Joel Boggan

Associate Professor of Medicine
I am a hospital medicine physician interested in quality improvement, patient safety, and medical education across the UME, GME, and CME environments. My current QI and research projects include work on readmissions, inpatient ORYX and patient experience measures, clinical documentation improvement, medication reconciliation, and appropriate utilization of inpatient resources. Alongside this work, I serve as the lead mentor for our Durham VA Chief Resident in Quality and Safety within the Depart

Luke Francis Chen

Associate Professor of Medicine
Epidemiology, Infection Prevention, Infection Control, Outbreak Investigations, Multi-drug resistant organisms, multidrug-resistant gram-negative pathogens MDR GNR (e.g. ESBL, CRE, KPC, NDM-1), C. difficile, MRSA infections health care epidemiology, HIV medicine, respiratory viral infections, infection control and prevention, health care-associated infections including bloodstream and surgical-site infections
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Dicks

Kristen V. Dicks

Assistant Professor of Medicine
Hegland

Donald Dale Hegland

Associate Professor of Medicine
Lewis

Sarah Stamps Lewis

Associate Professor of Medicine
Moehring

Rebekah Moehring

Associate Professor of Medicine
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