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Identification of Recurrent Clostridium difficile Infection Using Administrative Codes: Accuracy and Implications for Surveillance

Published online by Cambridge University Press:  30 April 2015

Jing Wen ,
Grant E. Barber  and
Ashwin N. Ananthakrishnan
Jing Wen
Affiliation:
Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
Grant E. Barber
Affiliation:
Harvard Medical School, Boston, Massachusetts
Ashwin N. Ananthakrishnan*
Affiliation:
Harvard Medical School, Boston, Massachusetts Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
*
Address correspondence to Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital, 165 Cambridge St, 9th Fl, Boston, MA 02114 ([email protected]).
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Abstract

OBJECTIVE

To develop an algorithm using administrative codes, laboratory data, and medication data to identify recurrent Clostridium difficile infection (CDI) and to examine the sensitivity, specificity, positive and negative predictive values, and performance of this algorithm.

METHODS

We identified all patients with 2 or more International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes for CDI (008.45) from January 1 through December 31, 2013. Information on number of diagnosis codes, stool toxin assays (enzyme immunoassay or polymerase chain reaction), and unique prescriptions for metronidazole and vancomycin was identified. Logistic regression was used to identify independent predictors of recurrent CDI and a predictive model was developed.

RESULTS

A total of 591 patients with at least 2 ICD-9 codes for CDI were included (median age, 66 years). The derivation cohort consisted of 157 patients among whom 43 (27%) had recurrent CDI. Presence of 3 or more ICD-9 codes for CDI (odds ratio, 2.49), 2 or more stool tests (odds ratio, 2.88), and 2 or more prescriptions for vancomycin (odds ratio, 5.87) were independently associated with confirmed recurrent CDI. A classifier incorporating 2 or more prescriptions for vancomycin and either 2 or more stool tests or 3 or more ICD-9-CM codes had a positive predictive value of 41% and negative predictive value of 90%. The area under the receiver operating characteristic curve for this combined classifier was modest (0.69).

CONCLUSION

Identification of recurrent episodes of CDI in administrative data poses challenges. Accurate assessment of burden requires individual case review to confirm diagnosis.

Infect Control Hosp Epidemiol 2015;36(8):893–898

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 893 - 898
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Ananthakrishnan, AN. Clostridium difficile infection: epidemiology, risk factors and management. Nat Rev Gastroenterol Hepatol 2011;8:17–26.CrossRefGoogle ScholarPubMed
2. Bartlett, JG. Clinical practice: antibiotic-associated diarrhea. N Engl J Med 2002;346:334–339.CrossRefGoogle ScholarPubMed
3. Bartlett, JG, Perl, TM. The new Clostridium difficile—what does it mean? N Engl J Med 2005;353:2503–2505.CrossRefGoogle ScholarPubMed
4. Gerding, DN. Clostridium difficile 30 years on: what has, or has not, changed and why? Int J Antimicrob Agents 2009;33:S2–S8.CrossRefGoogle Scholar
5. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
6. Mergenhagen, KA, Wojciechowski, AL, Paladino, JA. A review of the economics of treating Clostridium difficile infection. Pharmacoeconomics 2014;32:639–650.CrossRefGoogle ScholarPubMed
7. Dubberke, ER, Wertheimer, AI. Review of current literature on the economic burden of Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:57–66.CrossRefGoogle ScholarPubMed
8. Bartlett, JG, Gerding, DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 2008;46:S12–S18.CrossRefGoogle ScholarPubMed
9. Bauer, MP, Veenendaal, D, Verhoef, L, et al. Clinical and microbiological characteristics of community-onset Clostridium difficile infection in the Netherlands. Clin Microbiol Infect 2009;15:1087–1092.CrossRefGoogle ScholarPubMed
10. Pituch, H. Clostridium difficile is no longer just a nosocomial infection or an infection of adults. Int J Antimicrob Agents 2009;33:S42–S45.CrossRefGoogle ScholarPubMed
11. Khanna, S, Pardi, DS, Aronson, SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:89–95.CrossRefGoogle ScholarPubMed
12. Bauer, MP, van Dissel, JT, Kuijper, EJ. Clostridium difficile: controversies and approaches to management. Curr Opin Infect Dis 2009;22:517–524.CrossRefGoogle ScholarPubMed
13. Gerding, DN, Muto, CA, Owens, RC Jr.. Treatment of Clostridium difficile infection. Clin Infect Dis 2008;46:S32–S42.CrossRefGoogle ScholarPubMed
14. Johnson, S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009;58:403–410.CrossRefGoogle ScholarPubMed
15. McFarland, LV, Elmer, GW, Surawicz, CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:1769–1775.CrossRefGoogle ScholarPubMed
16. Surawicz, CM, McFarland, LV, Greenberg, RN, et al. The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii . Clin Infect Dis 2000;31:1012–1017.CrossRefGoogle ScholarPubMed
17. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
18. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478–498.CrossRefGoogle ScholarPubMed
19. Konijeti, GG, Sauk, J, Shrime, MG, et al. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis 2014;58:1507–1514.CrossRefGoogle ScholarPubMed
20. Varier, RU, Biltaji, E, Smith, KJ, et al. Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection. Clin Microbiol Infect 2014;20:1343–1351.CrossRefGoogle ScholarPubMed
21. Bartlett, JG. The case for vancomycin as the preferred drug for treatment of Clostridium difficile infection. Clin Infect Dis 2008;46:1489–1492.CrossRefGoogle ScholarPubMed
22. Musher, DM, Aslam, S, Logan, N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:1586–1590.CrossRefGoogle ScholarPubMed
23. Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31:262–268.CrossRefGoogle ScholarPubMed
24. Dubberke, ER, Reske, KA, McDonald, LC, et al. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.CrossRefGoogle ScholarPubMed
25. Shaklee, J, Zerr, DM, Elward, A, et al. Improving surveillance for pediatric Clostridium difficile infection: derivation and validation of an accurate case-finding tool. Pediatr Infect Dis J 2011;30:e38–e40.CrossRefGoogle ScholarPubMed
26. Welker, JA, Bertumen, JB. Toxin assay is more reliable than ICD-9 data and less time-consuming than chart review for public reporting of Clostridium difficile hospital case rates. J Hosp Med 2012;7:170–175.CrossRefGoogle ScholarPubMed
27. Dubberke, ER, Butler, AM, Nyazee, HA, et al. The impact of ICD-9-CM code rank order on the estimated prevalence of Clostridium difficile infections. Clin Infect Dis 2011;53:20–25.CrossRefGoogle ScholarPubMed
28. Scheurer, DB, Hicks, LS, Cook, EF, et al. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135:1010–1013.CrossRefGoogle ScholarPubMed
29. Schmiedeskamp, M, Harpe, S, Polk, R, et al. Use of International Classification of Diseases, Ninth Revision, Clinical Modification codes and medication use data to identify nosocomial Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:1070–1076.CrossRefGoogle ScholarPubMed
30. Nalichowski, R, Keogh, D, Chueh, HC, et al. Calculating the benefits of a Research Patient Data Repository. AMIA Annu Symp Proc 2006:1044.Google ScholarPubMed
31. Sahay, T, Ananthakrishnan, AN. Vitamin D deficiency is associated with community-acquired Clostridium difficile infection: a case-control study. BMC Infect Dis 2014;14:661.CrossRefGoogle ScholarPubMed
32. Charlson, ME, Pompei, P, Ales, KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
33. McDonald, LC, Coignard, B, Dubberke, E, et al. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
34. Lo Vecchio, A, Zacur, GM. Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol 2012;28:1–9.CrossRefGoogle ScholarPubMed
35. Louie, TJ, Miller, MA, Mullane, KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–431.CrossRefGoogle ScholarPubMed
36. van Nood, E, Speelman, P, Kuijper, EJ, et al. Struggling with recurrent Clostridium difficile infections: is donor faeces the solution? Euro Surveill 2009;14.Google ScholarPubMed
37. van Nood, E, Vrieze, A, Nieuwdorp, M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile . N Engl J Med 2013;368:407–415.CrossRefGoogle ScholarPubMed
38. Chan, M, Lim, PL, Chow, A, et al. Surveillance for Clostridium difficile infection: ICD-9 coding has poor sensitivity compared to laboratory diagnosis in hospital patients, Singapore. PLOS ONE 2011;6:e15603.CrossRefGoogle ScholarPubMed
39. Jones, G, Taright, N, Boelle, PY, et al. Accuracy of ICD-10 codes for surveillance of Clostridium difficile infections, France. Emerg Infect Dis 2012;18:979–981.CrossRefGoogle ScholarPubMed
40. Aichinger, E, Schleck, CD, Harmsen, WS, et al. Nonutility of repeat laboratory testing for detection of Clostridium difficile by use of PCR or enzyme immunoassay. J Clin Microbiol 2008;46:3795–3797.CrossRefGoogle ScholarPubMed
41. Khanna, S, Pardi, DS, Rosenblatt, JE, et al. An evaluation of repeat stool testing for Clostridium difficile infection by polymerase chain reaction. J Clin Gastroenterol 2012;46:846–849.CrossRefGoogle ScholarPubMed
42. Luo, RF, Banaei, N. Is repeat PCR needed for diagnosis of Clostridium difficile infection? J Clin Microbiol 2010;48:3738–3741.CrossRefGoogle ScholarPubMed
43. Van Hise, NW, Bryant, AM, Crannage, AJ, et al. Evaluation of secondary prophylaxis with oral vancomycin on the incidence of recurrent Clostridium difficile infections in high risk patients. In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 5-9, 2014; Washington, DC. Abstract K367.Google Scholar
44. Abou Chakra, CN, Pepin, J, Sirard, S, et al. Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PLOS ONE 2014;9:e98400.CrossRefGoogle ScholarPubMed