{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:31:46Z","timestamp":1765888306738,"version":"3.37.3"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T00:00:00Z","timestamp":1585008000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T00:00:00Z","timestamp":1585008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["17IG33630052","17IG33630052","17IG33630052","17IG33630052","17IG33630052","17IG33630052"],"award-info":[{"award-number":["17IG33630052","17IG33630052","17IG33630052","17IG33630052","17IG33630052","17IG33630052"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Procedure-related cardiac electronic implantable device (CIED) infections have high morbidity and mortality, highlighting the urgent need for infection prevention efforts to include electrophysiology procedures. We developed and validated a semi-automated algorithm based on structured electronic health records data to reliably identify CIED infections. A sample of CIED procedures entered into the Veterans\u2019 Health Administration Clinical Assessment Reporting and Tracking program from FY 2008\u20132015 was reviewed for the presence of CIED infection. This sample was then randomly divided into training (2\/3) validation sets (1\/3). The training set was used to develop a detection algorithm containing structured variables mapped from the clinical pathways of CIED infection. Performance of this algorithm was evaluated using the validation set. 2,107 unique CIED procedures from a cohort of 5,753 underwent manual review; 97 CIED infections (4.6%) were identified. Variables strongly associated with true infections included presence of a microbiology order, billing codes for surgical site infections and post-procedural antibiotic prescriptions. The combined algorithm to detect infection demonstrated high c-statistic (0.95; 95% confidence interval: 0.92\u20130.98), sensitivity (87.9%) and specificity (90.3%) in the validation data. Structured variables derived from clinical pathways can guide development of a semi-automated detection tool to surveil for CIED infection.<\/jats:p>","DOI":"10.1038\/s41598-020-62083-y","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T11:06:27Z","timestamp":1585047987000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Development and Validation of a Semi-Automated Surveillance Algorithm for Cardiac Device Infections: Insights from the VA CART program"],"prefix":"10.1038","volume":"10","author":[{"given":"Archana","family":"Asundi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7768-8868","authenticated-orcid":false,"given":"Maggie","family":"Stanislawski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Payal","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4484-0445","authenticated-orcid":false,"given":"Hillary J.","family":"Mull","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marin L.","family":"Schweizer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna E.","family":"Bar\u00f3n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. Michael","family":"Ho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalpana","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Westyn","family":"Branch-Elliman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,3,24]]},"reference":[{"key":"62083_CR1","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1016\/j.jacc.2011.04.033","volume":"58","author":"AJ Greenspon","year":"2011","unstructured":"Greenspon, A. J. et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol 58, 1001\u20131006, https:\/\/doi.org\/10.1016\/j.jacc.2011.04.033 (2011).","journal-title":"J Am Coll Cardiol"},{"key":"62083_CR2","doi-asserted-by":"publisher","first-page":"e000177","DOI":"10.1136\/openhrt-2014-000177","volume":"1","author":"PJ Bradshaw","year":"2014","unstructured":"Bradshaw, P. J., Stobie, P., Knuiman, M. W., Briffa, T. G. & Hobbs, M. S. Trends in the incidence and prevalence of cardiac pacemaker insertions in an ageing population. Open Heart 1, e000177, https:\/\/doi.org\/10.1136\/openhrt-2014-000177 (2014).","journal-title":"Open Heart"},{"key":"62083_CR3","doi-asserted-by":"publisher","unstructured":"Sohail, M. R. et al. Incidence, Treatment Intensity, and Incremental Annual Expenditures for Patients Experiencing a Cardiac Implantable Electronic Device Infection: Evidence From a Large US Payer Database 1-Year Post Implantation. Circ Arrhythm Electrophysiol 9, https:\/\/doi.org\/10.1161\/CIRCEP.116.003929 (2016).","DOI":"10.1161\/CIRCEP.116.003929"},{"key":"62083_CR4","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1001\/archinternmed.2011.441","volume":"171","author":"MR Sohail","year":"2011","unstructured":"Sohail, M. R., Henrikson, C. A., Braid-Forbes, M. J., Forbes, K. F. & Lerner, D. J. Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med 171, 1821\u20131828, https:\/\/doi.org\/10.1001\/archinternmed.2011.441 (2011).","journal-title":"Arch Intern Med"},{"key":"62083_CR5","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1111\/pace.13300","volume":"41","author":"AJ Greenspon","year":"2018","unstructured":"Greenspon, A. J., Eby, E. L., Petrilla, A. A. & Sohail, M. R. Treatment patterns, costs, and mortality among Medicare beneficiaries with CIED infection. Pacing Clin Electrophysiol 41, 495\u2013503, https:\/\/doi.org\/10.1111\/pace.13300 (2018).","journal-title":"Pacing Clin Electrophysiol"},{"key":"62083_CR6","doi-asserted-by":"publisher","first-page":"1540","DOI":"10.1016\/j.jacc.2012.07.017","volume":"60","author":"AJ Greenspon","year":"2012","unstructured":"Greenspon, A. J. et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures. J Am Coll Cardiol 60, 1540\u20131545, https:\/\/doi.org\/10.1016\/j.jacc.2012.07.017 (2012).","journal-title":"J Am Coll Cardiol"},{"key":"62083_CR7","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1097\/QCO.0000000000000282","volume":"29","author":"P Gastmeier","year":"2016","unstructured":"Gastmeier, P. & Behnke, M. Electronic surveillance and using administrative data to identify healthcare associated infections. Curr Opin Infect Dis 29, 394\u2013399, https:\/\/doi.org\/10.1097\/QCO.0000000000000282 (2016).","journal-title":"Curr Opin Infect Dis"},{"key":"62083_CR8","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1086\/502428","volume":"25","author":"A Borer","year":"2004","unstructured":"Borer, A. et al. Prevention of infections associated with permanent cardiac antiarrhythmic devices by implementation of a comprehensive infection control program. Infect Control Hosp Epidemiol 25, 492\u2013497, https:\/\/doi.org\/10.1086\/502428 (2004).","journal-title":"Infect Control Hosp Epidemiol"},{"key":"62083_CR9","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","volume":"10","author":"BJ Powell","year":"2015","unstructured":"Powell, B. J. et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci 10, 21, https:\/\/doi.org\/10.1186\/s13012-015-0209-1 (2015).","journal-title":"Implement Sci"},{"key":"62083_CR10","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1017\/ice.2015.216","volume":"36","author":"LF Chen","year":"2015","unstructured":"Chen, L. F., Vander Weg, M. W., Hofmann, D. A. & Reisinger, H. S. The Hawthorne Effect in Infection Prevention and Epidemiology. Infect Control Hosp Epidemiol 36, 1444\u20131450, https:\/\/doi.org\/10.1017\/ice.2015.216 (2015).","journal-title":"Infect Control Hosp Epidemiol"},{"key":"62083_CR11","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1089\/sur.2012.131","volume":"13","author":"SS Awad","year":"2012","unstructured":"Awad, S. S. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt) 13, 234\u2013237, https:\/\/doi.org\/10.1089\/sur.2012.131 (2012).","journal-title":"Surg Infect (Larchmt)"},{"key":"62083_CR12","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-017-0591-8","volume":"19","author":"W Branch-Elliman","year":"2017","unstructured":"Branch-Elliman, W. A Roadmap for Reducing Cardiac Device Infections: a Review of Epidemiology, Pathogenesis, and Actionable Risk Factors to Guide the Development of an Infection Prevention Program for the Electrophysiology Laboratory. Curr Infect Dis Rep 19, 34, https:\/\/doi.org\/10.1007\/s11908-017-0591-8 (2017).","journal-title":"Curr Infect Dis Rep"},{"key":"62083_CR13","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1097\/hcm.0000000000000196","volume":"37","author":"T Falen","year":"2018","unstructured":"Falen, T., Noblin, A. M., Russell, O. L. & Santiago, N. Using the Electronic Health Record Data in Real Time and Predictive Analytics to Prevent Hospital-Acquired Postoperative\/Surgical Site Infections. The health care manager 37, 58\u201363, https:\/\/doi.org\/10.1097\/hcm.0000000000000196 (2018).","journal-title":"The health care manager"},{"key":"62083_CR14","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1017\/ice.2018.170","volume":"39","author":"A Asundi","year":"2018","unstructured":"Asundi, A. et al. Prolonged antimicrobial prophylaxis following cardiac device procedures increases preventable harm: insights from the VA CART program. Infect Control Hosp Epidemiol 39, 1030\u20131036, https:\/\/doi.org\/10.1017\/ice.2018.170 (2018).","journal-title":"Infect Control Hosp Epidemiol"},{"key":"62083_CR15","doi-asserted-by":"publisher","unstructured":"Asundi, A. et al. Real-world effectiveness of infection prevention interventions for reducing procedure-related cardiac device infections: Insights from the veterans affairs clinical assessment reporting and tracking program. Infect Control Hosp Epidemiol, 1\u20138, https:\/\/doi.org\/10.1017\/ice.2019.127 (2019).","DOI":"10.1017\/ice.2019.127"},{"key":"62083_CR16","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1093\/europace\/eus350","volume":"14","author":"MG Bongiorni","year":"2012","unstructured":"Bongiorni, M. G. et al. How European centres diagnose, treat, and prevent CIED infections: results of an European Heart Rhythm Association survey. Europace 14, 1666\u20131669, https:\/\/doi.org\/10.1093\/europace\/eus350 (2012).","journal-title":"Europace"},{"key":"62083_CR17","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1161\/CIRCULATIONAHA.109.192665","volume":"121","author":"LM Baddour","year":"2010","unstructured":"Baddour, L. M. et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 121, 458\u2013477, https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.109.192665 (2010).","journal-title":"Circulation"},{"key":"62083_CR18","unstructured":"CDC. Surgical Site Infection (SSI) Event, http:\/\/www.cdc.gov\/nhsn\/PDFs\/pscManual\/9pscSSIcurrent.pdf (2015)."},{"key":"62083_CR19","doi-asserted-by":"publisher","DOI":"10.1186\/1755-8794-4-31","volume":"4","author":"KK Dobbin","year":"2011","unstructured":"Dobbin, K. K. & Simon, R. M. Optimally splitting cases for training and testing high dimensional classifiers. BMC Med Genomics 4, 31, https:\/\/doi.org\/10.1186\/1755-8794-4-31 (2011).","journal-title":"BMC Med Genomics"},{"key":"62083_CR20","unstructured":"McLeod, A. I. & Xu, C. bestglm: Best subset GLM and Regression Utilities. R package version 0.37, https:\/\/CRAN.R-project.org\/package=bestglm (2018)."},{"key":"62083_CR21","unstructured":"Kuhn, M., Contributions from Jed Wing, S. W., Andre Williams, Chris, Keefer, A. E., Tony Cooper, Zachary Mayer, Brenton Kenkel, the R & Core Team, M. B., Reynald Lescarbeau, Andrew Ziem, Luca Scrucca, Yuan Tang, Can Candan and Tyler Hunt. caret: Classification and Regression Training. R package version 6.0-81. https:\/\/CRAN.R-project.org\/package=caret (2018)."},{"key":"62083_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2105-12-77","volume":"12","author":"X Robin","year":"2011","unstructured":"Robin, X. et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 12, 77, https:\/\/doi.org\/10.1186\/1471-2105-12-77 (2011).","journal-title":"BMC Bioinformatics"},{"key":"62083_CR23","first-page":"3","volume":"1","author":"G Nattino","year":"2017","unstructured":"Nattino, G., Finazzi, S., Bertolini, G. & Rossi, C. & Carrara, G. givitiR: The GiViTI Calibration Test and Belt. R package version 1, 3 (2017).","journal-title":"R package version"},{"key":"62083_CR24","doi-asserted-by":"publisher","first-page":"691","DOI":"10.2307\/2337038","volume":"78","author":"NJD Nagelkerke","year":"1991","unstructured":"Nagelkerke, N. J. D. A Note on a General Definition of the Coefficient of Determination. Biometrika 78, 691\u2013692, https:\/\/doi.org\/10.2307\/2337038 (1991).","journal-title":"Biometrika"},{"key":"62083_CR25","unstructured":"Signorell et mult. al., A. DescTools: Tools for Descriptive Statistics. R package version 0.99.32. (2020)."},{"key":"62083_CR26","unstructured":"R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, https:\/\/www.R-project.org\/ (2018)."},{"key":"62083_CR27","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1017\/ice.2016.116","volume":"37","author":"W Branch-Elliman","year":"2016","unstructured":"Branch-Elliman, W. et al. Cardiac Electrophysiology Laboratories: A Potential Target for Antimicrobial Stewardship and Quality Improvement? Infect Control Hosp Epidemiol 37, 1005\u20131011, https:\/\/doi.org\/10.1017\/ice.2016.116 (2016).","journal-title":"Infect Control Hosp Epidemiol"},{"key":"62083_CR28","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1136\/amiajnl-2013-002089","volume":"21","author":"JS de Bruin","year":"2014","unstructured":"de Bruin, J. S., Seeling, W. & Schuh, C. Data use and effectiveness in electronic surveillance of healthcare associated infections in the 21st century: a systematic review. Journal of the American Medical Informatics Association: JAMIA 21, 942\u2013951, https:\/\/doi.org\/10.1136\/amiajnl-2013-002089 (2014).","journal-title":"Journal of the American Medical Informatics Association: JAMIA"},{"key":"62083_CR29","doi-asserted-by":"publisher","first-page":"ofv128","DOI":"10.1093\/ofid\/ofv128","volume":"2","author":"JC Boggan","year":"2015","unstructured":"Boggan, J. C. et al. An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures. Open Forum Infect Dis 2, ofv128, https:\/\/doi.org\/10.1093\/ofid\/ofv128 (2015).","journal-title":"Open Forum Infect Dis"},{"key":"62083_CR30","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1086\/605086","volume":"49","author":"MA Jhung","year":"2009","unstructured":"Jhung, M. A. & Banerjee, S. N. Administrative coding data and health care-associated infections. Clin Infect Dis 49, 949\u2013955, https:\/\/doi.org\/10.1086\/605086 (2009).","journal-title":"Clin Infect Dis"},{"key":"62083_CR31","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1086\/657936","volume":"32","author":"ML Schweizer","year":"2011","unstructured":"Schweizer, M. L. et al. Validity of ICD-9-CM coding for identifying incident methicillin-resistant Staphylococcus aureus (MRSA) infections: is MRSA infection coded as a chronic disease? Infect Control Hosp Epidemiol 32, 148\u2013154, https:\/\/doi.org\/10.1086\/657936 (2011).","journal-title":"Infect Control Hosp Epidemiol"},{"key":"62083_CR32","doi-asserted-by":"publisher","first-page":"ofu106","DOI":"10.1093\/ofid\/ofu106","volume":"1","author":"MS Calderwood","year":"2014","unstructured":"Calderwood, M. S., Kleinman, K., Murphy, M. V., Platt, R. & Huang, S. S. Improving public reporting and data validation for complex surgical site infections after coronary artery bypass graft surgery and hip arthroplasty. Open forum infectious diseases 1, ofu106, https:\/\/doi.org\/10.1093\/ofid\/ofu106 (2014).","journal-title":"Open forum infectious diseases"},{"key":"62083_CR33","doi-asserted-by":"publisher","first-page":"e42","DOI":"10.1097\/MLR.0000000000001010","volume":"57","author":"AJ Mainor","year":"2019","unstructured":"Mainor, A. J., Morden, N. E., Smith, J., Tomlin, S. & Skinner, J. ICD-10 Coding Will Challenge Researchers: Caution and Collaboration may Reduce Measurement Error and Improve Comparability Over Time. Med Care 57, e42\u2013e46, https:\/\/doi.org\/10.1097\/MLR.0000000000001010 (2019).","journal-title":"Med Care"},{"key":"62083_CR34","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1089\/sur.2016.262","volume":"18","author":"KD Cato","year":"2017","unstructured":"Cato, K. D., Liu, J., Cohen, B. & Larson, E. Electronic Surveillance of Surgical Site Infections. Surg Infect (Larchmt) 18, 498\u2013502, https:\/\/doi.org\/10.1089\/sur.2016.262 (2017).","journal-title":"Surg Infect (Larchmt)"},{"key":"62083_CR35","unstructured":"Branch-Elliman, W., Gupta, K. & Elwy, A. in IDWeek 2019."},{"key":"62083_CR36","unstructured":"Quality, T. A. f. H. R. a. About Learning Health Systems., https:\/\/www.ahrq.gov\/learning-health-systems\/about.html (2019)."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62083-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62083-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62083-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T08:36:57Z","timestamp":1670315817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-62083-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,24]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["62083"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-62083-y","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2020,3,24]]},"assertion":[{"value":"19 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"AA is an investigator for studies funded by Gilead Sciences and Merck since the completion of this study. WBE is a consultant for DLA Piper, LLC.\u00a0All other authors declare that have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"5276"}}