/dr_thomas_f._obrien

Surveillance of The World s Infecting Microbes And Their Resistance to Antimicrobial Agents Thomas F. O Brien, M.D. World Health Organization Collaborating Center for Surveillance of Antimicrobial Resistance Brigham and Women s Hospital and Harvard Medical School, Boston MA, USA

FILES

LAB REPORTS

HOSPITAL

COMMUNITY

MICROBIOLOGY LABORATORY FILES - Sample widely hospital, community bacteria - All we can know of bacterial trends, distribution - Only lab needing analysis across patients FILES

BUT CAN NOT ANALYZE PAPER FILES

LAB REPORTS

HOSPITAL

COMMUNITY

Enter results into the WHONET database WHONET makes the reports WHONET retrieves results and can make a logbook WHONET DOES ANALYSES WHONET LOGBOOK

ANALYSIS LAB

HOSPITAL

COMMUNITY

NETWORK

WHONET

WHONET LOGBOOK

LOGBOOK

A

ANALYSIS LAB

LAB

HOSPITAL

COMMUNITY

HOSPITAL

COMMUNITY

Many laboratories now have Lab Information Systems (LIS) An LIS transmits and retrieves reports electronically Most LISs can not analyze Most LISs are incompatible with one another

LAB INFORMATION SYSTEM

LAB

HOSPITAL

COMMUNITY

X

LAB INFORMATION SYSTEM

?

NO ANALYSIS

LAB

HOSPITAL

COMMUNITY

A

ENCRYPT

ENCRYPT

WHONET

WHONET NETWORK

BACLINK

LAB INFORMATION SYSTEM

LAB

HOSPITAL

COMMUNITY

BACLINK

ANALYSIS

X

LAB INFORMATION SYSTEM

?

NO ANALYSIS

LAB

HOSPITAL

COMMUNITY

A

R

I

S

PSEUDOMONAS AT CENTER C

01020304050607080901006810121416182022242628303234>

%

N = 464

% OF ISOLATES

%

DIAMETERS (MM) OF CARBENICILLIN ZONES OF INHIBITION

PSEUDOMONAS PSEUDOMONAS AT CENTER CENTER D D AT N == 273 273 N

DIAMETERS (MM) OF ZONES OF INHIBITION AROUND CARBENICILLIN DISK

R

I

S

ENTEROCOCCI ENTEROCOCCI ATATCENTER CENTERA A N =2140 1207 N=

%

%

OF ISOLATES

%

ENTEROCOCCI AT CENTER B N = 2140

DIAMETERS (MM) OF VANCOMYCIN ZONES OF INHIBITION

200 180 160 140 120 No. of 100 Pts. 80 60 40 20 0

Patients/Year with Staphylococcal Bacteremia at one Center

MRSA MSSA

93 94 95 96 97 98 99 00 01 02 03 04

Year

ISOLATES OF STREPTOCOCCUS PNEUMONIAE

ISOLATES OF KLEBSIELLA PNEUMONIAE

JUNE NOVEMBER

DIAMETERS (MM) OF ZONES OF INHIBITION AROUND CEFTAZIDIME (CAZ) AND CEFTIZOXIME (CZX) DISKS. NUMBERS = PERCENT OF ISOLATES

ISOLATES OF KLEBSIELLA PNEUMONIAE

JUNE NOVEMBER N = 443

DECEMBER N = 115

DIAMETERS (MM) OF ZONES OF INHIBITION AROUND CEFTAZIDIME (CAZ) AND CEFTIZOXIME (CZX) DISKS. NUMBERS = PERCENT OF ISOLATES

ISOLATES OF KLEBSIELLA PNEUMONIAE

N = 443

DECEMBER

N = 115

DIAMETERS (MM) OF ZONES OF INHIBITION AROUND CEFTAZIDIME (CAZ) AND CEFTIZOXIME (CZX) DISKS. NUMBERS = PERCENT OF ISOLATES

Identification number

Location

PATIENT C_

4d-31

3/23/2010

4d-31 PATIENT F_ PATIENT D_

Specimen date

AM K

CAZ

CRO

CI P

FOX

6607735453164010

>32

16

>32

>32

>2

<=.5

3/24/2010

6607735453164010

>32

8

>32

>32

>2

4d-31

3/24/2010

6607734453164010

>32

8

>32

>32

4d-31

4/12/2010

6607735553164010

>32

16

>32

4d-31

4/12/2010

6607735553164010

>32

16

8a-17

3/26/2010

6607734653164010

>32

8a-17

3/26/2010

6607734653164010

>32

8c-59

4/1/2010

6607734653164010

>32

8c-59

4/3/2010

6607734653164010

>32

8c-55

4/8/2010

6607734653164010

>32

Bionumber

G E N

IPM

LV X

TZP

TO B

SXT

4

<=1

>4

>64

>8

>8

<=.5

4

<=1

>4

>64

>8

>8

>2

<=.5

4

<=1

>4

>64

>8

>8

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

<=1

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

<=1

>32

>32

>32

>2

>4

4

<=1

>4

>64

>8

<=1

>32

>32

>32

>2

>4

4

<=1

>4

>64

>8

8

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

<=1

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

<=1

>32

>32

>2

4

<=1

>4

>64

>8

ETP

2

8c-51

5/4/2010

6607734653164010

>32

PATIENT A_

ab10e-

1/30/2010

6607734653164010

>32

_PATIENT B

4d-721

3/9/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-721

3/11/2010

6607735453164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

3/18/2010

6607735553564010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

4/1/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

4/1/2010

6607735453564010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

4/1/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

4/7/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

4/8/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8c-58

4/14/2010

6607735453164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

8d-75

4/15/2010

6607734453164010

>32

>32

>32

>2

>4

4

>4

>64

>8

4d-21

3/27/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

3/29/2010

6607734453164010

>32

8

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

4/4/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

4/6/2010

6607735453164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

4/14/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

4/17/2010

6627735551565150

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

4/17/2010

6607735453164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

<=1

4d-21

4/17/2010

6607735453164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

4d-21

4/27/2010

6607735553164010

>32

16

>32

>32

>2

<=.5

4

<=1

>4

>64

>8

>8

5/28/2010

6627735553564110

>32

>32

>32

>2

>4

4

<=1

>4

>64

>8

>8

_PATIENT F_

>32

>32

>32

4

2

2

2

WHONET NEW : SaTScan is statistical software for detecting spatial and temporal clusters in public health databases SaTScan has been integrated into the tools and charts of WHONET The following show WHONET-SaTScan analyses detecting clusters in existing databases WHONET-SaTScan can also run prospectively to automate detection of and alerting to new clusters going forward in real-time.

# Acinetobacter isolates (first isolate, one per patient)

12

0 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05

A. baumannii, 2003-2005 Resistance profile =ACFGLNT

14

Start: 10/2/04 End: 12/29/05

10

8

6

4

2

ACFLNGT = Non-susceptible to 7 antimicrobials A=Ampicillin, C=Cefotaxime, F=Ceftazidime, L=Levofloxacin, N=Nitrofurantoin, G=Gentamicin, T=Trim/Sulfa

PATIENT

ISOLATES OF ESCHERICHIA COLI

DAY SPECIMEN

A

1

URINE

A

30

BLOOD

A

30

URINE

A

31

BLOOD

A

31

BLOOD

WHONET supports: 1. Antimicrobial selection and policy 2. Infection control 3. Local, national, global surveillance 4. Laboratory capacity building (CQI) 5. Signal/event detection (BacTrak) whonet.org

The worlds microbiology laboratories should upload their results each day into programs that detect events, trends and epidemics in communities, hospitals, countries and the world