Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-09T09:15:53.805Z Has data issue: false hasContentIssue false

Use of International Classification of Diseases, Ninth Revision Clinical Modification Codes and Medication Use Data to Identify Nosocomial Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Mia Schmiedeskamp
Affiliation:
Department of Pharmacy, College of Pharmacy, University of Illinois at Chicago, Chicago
Spencer Harpe
Affiliation:
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
Ronald Polk
Affiliation:
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
Michael Oinonen
Affiliation:
University HealthSystem Consortium, Oak Brook, Illinois
Amy Pakyz*
Affiliation:
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia
*
Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533 ([email protected])

Abstract

Objective.

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for Clostridium difficile infection (CDI) is used for surveillance of CDI. However, the ICD-9-CM code alone cannot separate nosocomial cases from cases acquired outside the institution. The purpose of this study was to determine whether combining the ICD-9-CM code with medication treatment data for CDI in hospitalized patients could enable us to distinguish between patients with nosocomial CDI and patients who were admitted with CDI. The primary objective was to compare the sensitivity, specificity, and predictive value of using the combination of ICD-9-CM code for CDI and CDI treatment records to identify cases of nosocomial CDI with the sensitivity, specificity, and predictive value of using the ICD-9-CM code alone.

Design.

Validation sample cross-sectional study.

Setting.

Academic health center.

Methods.

Administrative claims data from July 1, 2004, to June 30, 2005, were queried to identify adults discharged with an ICD-9-CM code for CDI and to find documentation of CDI therapy with oral vancomycin or metronidazole. Laboratory and medical records were queried to identify symptomatic CDI toxin-positive adult patients with nosocomial CDI and were compared with records of patients whose cases were predicted to be nosocomial by means of ICD-9-CM code and CDI therapy data.

Results.

Of 23,920 adult patients discharged from the hospital, 62 had nosocomial CDI according to symptoms and toxin assay. The sensitivity of the ICD-9-CM code alone for identifying nosocomial CDI was 96.8%, the specificity was 99.6%, the positive predictive value was 40.8%, and the negative predictive value was 100%. When CDI drug therapy was included with the ICD-9-CM code, the sensitivity ranged from 58.1% to 85.5%, specificity was virtually unchanged, and the range in positive predictive value was 37.9%–80.0%.

Conclusion.

Combining the ICD-9-CM code for CDI with drug therapy information increased the positive predictive value for nosocomial CDI but decreased the sensitivity.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Musher, DM, Aslam, S, Logan, N, et al.Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:15861590.CrossRefGoogle ScholarPubMed
2.Pepin, J, Alary, M-E, Valiquette, L, et al.Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:15911597.Google Scholar
3.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in subjects discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006;12:409415.CrossRefGoogle Scholar
4.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.Google Scholar
5.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.CrossRefGoogle ScholarPubMed
6.Warny, M, Pepin, J, Fang, A, et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:10791084.CrossRefGoogle ScholarPubMed
7.Frost, F, Craun, GF, Calderon, RL. Increasing hospitalization and death possibly due to Clostridium difficile diarrheal disease. Emerg Infect Dis 1998;4:619625.Google Scholar
8.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK, Ad Hoc Clostridium difficile Surveillance Working Group. Recommendations for surveillance of Clostridium difficile–associated disease. Infect Control Hosp Epidemiol 2007;28:140145.Google Scholar
9.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Atlanta, GA: Centers for Disease Control and Prevention, 2006. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroguideline2006.pdf. Accessed May 14, 2009.Google Scholar
10.Dubberke, ER, Gerding, DN, Classen, D, et al.Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S81S92.Google Scholar
11.Ricciardi, R, Rothenberger, DA, Madoff, RD, Baxter, NN. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007;142:624631.CrossRefGoogle ScholarPubMed
12.Chandler, RE, Hedberg, K, Cieslak, PR. Clostridium difficile–associated disease in Oregon: increasing incidence and hospital-level risk factors. Infect Control Hosp Epidemiol 2007;28:116122.CrossRefGoogle ScholarPubMed
13.O'Brien, JA, Lahue, BJ, Caro, JJ, Davidson, DM. The emerging infectious challenge of Clostridium difficile–associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol 2007;28:12191227.Google Scholar
14.Zilberberg, MD, Shorr, AF, Kollef, MH. Increase in adult Clostridium difficile–related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis 2008;14:929931.Google Scholar
15.Iezzoni, LI. Coded data from administrative sources. In: Iezzoni, LI, ed. Risk Adjustment for Measuring Health Care Outcomes, 3rd ed. Chicago, IL: Health Administration Press; 2003: 83138.Google Scholar
16.Gerding, DN, Muto, CA, Owens, RC. Treatment of Clostridium difficile infection. Clin Infect Dis 2008;46(Suppl 1):S32S42.CrossRefGoogle ScholarPubMed
17.Pakyz, AL, MacDougall, C, Oinonen, M, Polk, RE. Trends in antibacterial use in US academic health centers. Arch Intern Med 2008;168:22542260.CrossRefGoogle ScholarPubMed
18.Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:15761579.Google Scholar
19.Scheurer, DB, Hicks, LS, Cook, EF, Schnipper, JL. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135:10101013.CrossRefGoogle ScholarPubMed
20.Bartlett, JG, Gerding, DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 2008;46(Suppl 1):S12S18.Google Scholar
21.Centers for Medicare and Medicaid Services. Hospital-acquired conditions (present on admission indicator). Baltimore, MD: Centers for Medicare and Medicaid Services. Updated July 20, 2009. Available at http://www.cms.hhs.gov/HospitalAcqCond/. Accessed May 14, 2009.Google Scholar