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Interactive data visualizations of antibiotic use and resistance in North America and Europe
Medical investigators and decision-makers often rely on administrative codes to gauge infections rates and outcomes of methicillin-resistant Staphylococcus aureus (MRSA). One such database is the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Is this method of assessment reliable?
49% of hospitalized patients in the study who were classified as infected with MRSA had no record of a MRSA infection during their hospital stay. The agreement between MRSA classification and actual presence of MRSA infection had a κ coefficient of 0.26.
Based on the results of the study, the current ICD-9-CM is not a precise indicator of MRSA infection and should not be used to measure rates of MRSA infection.
Background and Objective: Investigators and medical decision makers frequently rely on administrative databases to assess methicillin-resistant Staphylococcus aureus (MRSA) infection rates and outcomes. The validity of this approach remains unclear. We sought to assess the validity of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for infection with drug- resistant microorganisms (V09) for identifying culture-proven MRSA infection.
Design: Retrospective cohort study.
Methods: All adults admitted to 3 geographically distinct hospitals between January 1, 2001, and December 31, 2007, were assessed for presence of incident MRSA infection, defined as an MRSA-positive clinical culture obtained during the index hospitalization, and presence of the V09 ICD-9-CM code. The k statistic was calculated to measure the agreement between presence of MRSA infection and assignment of the V09 code. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated.
results. There were 466,819 patients discharged during the study period. Of the 4,506 discharged patients (1.0%) who had the V09 code assigned, 31% had an incident MRSA infection, 20% had prior history of MRSA colonization or infection but did not have an incident MRSA infection, and 49% had no record of MRSA infection during the index hospitalization or the previous hospitalization. The V09 code identified MRSA infection with a sensitivity of 24% (range, 21%–34%) and positive predictive value of 31% (range, 22%–53%). The agreement between assignment of the V09 code and presence of MRSA infection had a k coefficient of 0.26 (95% confidence interval, 0.25–0.27).
Conclusions: In its current state, the ICD-9-CM code V09 is not an accurate predictor of MRSA infection and should not be used to measure rates of MRSA infection.