An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures.
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.
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https://hdl.handle.net/10161/12047Published Version (Please cite this version)
10.1093/ofid/ofv128Publication 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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Show full item recordScholars@Duke
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
Arthur Wakefield Baker
Associate Professor of Medicine
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.
Kristen V. Dicks
Assistant Professor of Medicine
Donald Dale Hegland
Associate Professor of Medicine
Sarah Stamps Lewis
Associate Professor of Medicine
Rebekah Moehring
Associate Professor of Medicine
Alphabetical list of authors with Scholars@Duke profiles.

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