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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 (aananthakrishnan@mgh.harvard.edu).
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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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