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Predictive Ability of Positive Clinical Culture Results and International Classification of Diseases, Ninth Revision, to Identify and Classify Noninvasive Staphylococcus aureus Infections: A Validation Study

Published online by Cambridge University Press:  02 January 2015

LaRee A. Tracy ,
Jon P. Furuno ,
Anthony D. Harris ,
Mary Singer ,
Patricia Langenberg  and
Mary-Claire Roghmann
LaRee A. Tracy*
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Jon P. Furuno
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Mary Singer
Affiliation:
Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
Patricia Langenberg
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
Mary-Claire Roghmann
Affiliation:
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore
*
University of Maryland, Baltimore, Baltimore, MD ([email protected])
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Extract

Objective.

To develop and validate an algorithm to identify and classify noninvasive infections due to Staphylococcus aureus by using positive clinical culture results and administrative data.

Design.

Retrospective cohort study.

Setting.

Veterans Affairs Maryland Health Care System.

Methods.

Data were collected retrospectively on all S. aureus clinical culture results from samples obtained from nonsterile body sites during October 1998 through September 2008 and associated administrative claims records. An algorithm was developed to identify noninvasive infections on the basis of a unique S. aureus-positive culture result from a nonsterile site sample with a matching International Classification of Diseases, Ninth Revision (ICD-9-CM), code for infection at time of sampling. Medical records of a subset of cases were reviewed to find the proportion of true noninvasive infections (cases that met the Centers for Disease Control and Prevention National Healthcare Safety Network [NHSN] definition of infection). Positive predictive value (PPV) and negative predictive value (NPV) were calculated for all infections and according to body site of infection.

Results.

We identified 4,621 unique S. aureus-positive culture results, of which 2,816 (60.9%) results met our algorithm definition of noninvasive S. aureus infection and 1,805 (39.1%) results lacked a matching ICD-9-CM code. Among 96 cases that met our algorithm criteria for noninvasive S. aureus infection, 76 also met the NHSN criteria (PPV, 79.2% [95% confidence interval, 70.0%–86.1%]). Among 98 cases that failed to meet the algorithm criteria, 80 did not meet the NHSN criteria (NPV, 81.6% [95% confidence interval, 72.8%–88.0%]). The PPV of all culture results was 55.4%. The algorithm was most predictive for skin and soft-tissue infections and bone and joint infections.

Conclusion.

When culture-based surveillance methods are used, the addition of administrative ICD-9-CM codes for infection can increase the PPV of true noninvasive S. aureus infection over the use of positive culture results alone.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 7 , July 2010 , pp. 694 - 700
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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