LAUSR

Abstract Background Surveillance is an essential aspect of infection prevention. Despite the high morbidity and mortality associated with procedure-related Cardiac Implantable Electronic Device (CIED) infections, methods for identifying them are limited. The objective of this study was to develop an algorithm with electronic flags to facilitate detection of CIED infections in a large, multi-center cohort. Methods A sample of patients who underwent CIED procedures entered into the VA Clinical Assessment Reporting and Tracking Electrophysiology (CART-EP) program from FY 2007 to 2015 were included in the nested case–control study. After cohort creation, data from this review process were combined with electronic variables (e.g., microbiology orders, ICD 9/10 codes) to develop a preliminary algorithm that categorized patients as high, intermediate, or low risk of CIED infection. Results A total of 1,014 unique patients out of a cohort of 5,955 procedures underwent manual review. Among these cases, 59 CIED infections and 955 controls were identified. Electronic variables predictive of CIED infection included ICD 9/10 infection codes and microbiology orders (table). ICD 9/10 codes had excellent PPV for flagging infections but sensitivity was limited (47.5%, see figure). Adding microbiology order flags increased sensitivity but lowered specificity. Specificity in patients without either flag was outstanding (99%).Table: Electronic flags for CIED infection Infection flag Infection (N = 59) No infection (N = 955) OR P-value CIED infection ICD 9/10 21/59 (35.6%) 1/955 (0.10%) 340 <0.001 Surgical site infection (SSI) ICD 9/10 7/59 (11.9%) 6/955 (0.63%) 18.9 <0.001 CIED infection or SSI ICD 9/10 28/59 (47.5%) 7/955 (0.73%) 64.7 <0.001 Micro order* 53/59 (89.8%) 198/955 (20.7%) 5.4 <0.001 *Blood, wound, and unclassified cultures. Conclusion Absence of ICD 9/10 and microbiology orders is highly specific for ruling out CIED infections. The discriminatory abilities of the algorithm for intermediate probability flags (+microbiology/−ICD9/10) need improvement. In patients without ICD codes, at least microbiology orders should be used as a flag to streamline review of possible device infections. Refinement of this tool using other clinical flags may improve operating characteristics and clinical utility. Disclosures W. Branch-Elliman, Veterans’ Integrated Service Network Career Development Award: Investigator, Research grant. American Heart Association: Investigator, Research grant.