Role of the Laboratory in Antimicrobial Resistance Data

The Role of the Laboratory Collection, Analysis & Circulation of Antimicrobial Resistance Data Dr Anuj Sharma World Health Organization, India

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Role of Microbiology Lab ,[object Object],[object Object],[object Object],[object Object],Interaction between the microbiology laboratory and clinician: what the microbiologist can provide Journal of Hospital Infection Vol. 43, Supplement 1, Dec99, S285-S291; 4th International Conference of the Hospital Infection Society

Uses of AMR Data ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Antibiogramme (ABGM) ,[object Object]

Why prepare an antibiogramme? ,[object Object],[object Object]

12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults ,[object Object],[object Object],[object Object],[object Object],Campaign to Prevent Antimicrobial Resistance in Healthcare Settings 12 Break the chain 11 Isolate the pathogen 10 Stop treatment when cured 9 Know when to say “no” to vanco 8 Treat infection, not colonization 7 Treat infection, not contamination 6 Use “local” data 5 Practice antimicrobial control 4 Access the experts 3 Target the pathogen 2 Get the catheters out 1 Vaccinate Prevent Transmission Use Antimicrobials Wisely Diagnose & Treat Effectively Prevent Infections

Why prepare an antibiogramme? ,[object Object],[object Object],[object Object]

Antimicrobial Stewardship ,[object Object],[object Object],[object Object],[object Object],IDSA/SHEA – Guidelines for developing an Institutional Program to Enhance Antimicrobial Stewardship CID 2007:44;159-177

Why prepare an antibiogramme? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CLSI guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object]

Antibiogramme (ABGM) ,[object Object],[object Object],[object Object],[object Object],CLSI. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. M39-2A, 2005

Antibiogramme Desirable features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CLSI. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. M39-2A, 2005

Antibiogramme Analysis ABGM Variability in 65 US hospitals Analysis and Presentation of Cumulative Antimicrobial Susceptibility Data (Antibiograms) Substantial Variability Across Medical Centers in the United States. Infect Control Hosp Epidemiol Apr2006; 27:409-412

Antibiogramme Quality indicators ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],JCM. Nationwide ABGM analysis using NCCLS M39-A Guidelines. Jun2005:43(6);2629-33

Verify the data "It checks out OK on the computer… now let's confirm it with the pendulum"

GNB trends ABC hospital: 2005-2007 Green = susceptibility increased by greater than 10% during the study period Red = susceptibility decreased by greater than 10%, Yellow = change less than 10% but clinically significant resistance exist Drug E. coli Pseud. aeruginosa Kleb. pnuemo. Proteus mirabilis Enterob. cloacae Serratia marcescens Enterob. aerogenes Ampicillin 63 49 Amp-Sul 64 75 Pip-Tzp 59 83 Ceftriaxone 65 Ceftazidime 71 68 89 Cefipime 62 Levofloxacin 85 R 46 75 Cipro 85 R 46 75 Gentamicin 57 62 Tobramycin 58 87 86 Cotrimoxazole 57 Imipenem 77

GPC R-trends XYZ hospital: 2004-2007 MRSA and VRE trends 20% 40% 60% 80% 2004 2005 2006 2007 MRSA % 0% 1% 2% 3% 4% 5% 6% VRE % MRSA VRE

Distribution of ABGM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CLSI M39-A2

SGRH http://www.sgrh.com/newsletters/mb%20jul%202007.pdf

http://www.sgrh.com/category.aspx?id=10 ,[object Object],[object Object],[object Object],[object Object]

CNBC http://cnbc.delhigovt.nic.in/pdf/Newsletter.pdf

FH-N/VK Courtesy: Dr Ashok Rattan

WHONET A Microbiology Data Management Tool ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lab Networking in India ,[object Object],[object Object],[object Object],[object Object]

WHONET facilitates ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

WHONET ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

BacLink software Import & analyze antimicrobial susceptibility data from software / automated ABST instruments Comp Software Lab Systems WHONET BacLink Excel Access EpiInfo Lab Instruments Mysis MEDITECH ADBakt MIC systems Disk diffusion readers Data analysis Data Conversion

Laboratory Information Systems & Other Formats ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Susceptibility Test Instruments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

WHONET Use in the World >1300 laboratories in >90 countries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

http://www.who.int/drugresistance/whonetsoftware/en/ Free download

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Role of the Laboratory in Antimicrobial Resistance Data

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