# Presentation: 161821

## WHONET and BacLinkLaboratory-based surveillance of infectious diseases and antimicrobial resistance

- John Stelling, MD, MPH
- Brigham and Women’s Hospital, Boston
- WHO Collaborating Centre for Surveillance of Antimicrobial Resistance
- jstelling@rics.bwh.harvard.edu

## The Complete Laboratory Information System

- Clinical reporting
- return results to clinicians
- permanent record
- Laboratory management system
- preliminary and final results
- guide technologists through needed laboratory tests
- billing and financial accounting
- Data analysis

## Uses of Microbiology Data

- Laboratory quality improvement
- Laboratory testing
- Utilization of laboratory services by clinical staff
- Infection control and outbreak preparedness
- Identification of new and problem pathogens
- Identification and investigation of outbreaks
- Antimicrobial policy
- Trends in infections and resistance
- Characterization of cross-resistance
- Development of treatment guidelines
- Research
- New resistance mechanisms
- Risk factors for resistance
- Evaluation of interventions

## WHONET:  A Microbiology Data Management Tool

- Enhance the use of locally-generated data
- Antimicrobial policy, infection control
- Laboratory quality assurance
- Promote collaborations
- National and international networks

## WHONET around the World

- WHONET is currently used in over 90 countries, managing data from over 1300 laboratories.
- Hospital and public health laboratories
- Food and veterinary laboratories
- Reference and research laboratories
- Data collections
- Routine laboratory data
- Special surveys and research protocols

## WHONET Use in the World

**African Regional Office of WHO (AFRO)**
- Algeria, Kenya, Namibia, South Africa, Tanzania, Zambia
**Eastern Mediterranean Regional Office of WHO (EMRO)**
- Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Saudi Arabia, Tunisia
**European Regional Office of WHO (EURO)**
- Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Iceland, Ireland, Israel, Italy, Latvia, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Slovenia, Spain, Sweden, Ukraine, United Kingdom
**Pan-American Health Organization (PAHO)**
- Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, United States, Uruguay, Venezuela
**South-East Asian Regional Office of WHO (SEARO)**
- India, Indonesia, Sri Lanka, Thailand
**Western Pacific Regional Office of WHO (WPRO)**
- China, Hong Kong (China), Japan, Republic of Korea, Malaysia, Philippines, Singapore, Taiwan, Viet Nam

## WHONET Availability

- Free of charge from WHO
- www.who.int/drugresistance/whonetsoftware
- The software includes 18 languages
- English, Estonian, French, German, Italian, Latvian, Norwegian (two dialects), Polish, Portuguese, Spanish
- Bulgarian, Greek, Russian
- Chinese (Simplified), Indonesian, Japanese, Thai

## Isolate listing:  List of patients with MRSA

## Isolate Summary:Number of patients with MRSA by location and month

## %RIS and histograms:  Pseudomonas aeruginosa

- %RIS and histograms:  *Pseudomonas aeruginosa*

## Scatterplot - Klebsiella pneumoniae Amikacin vs. Gentamicin

## Staphylococcus aureusTotal and by Resistance Profile

## BacTrack Expert SystemIsolate alerts

- BacTrack Expert SystemIsolate alerts

## Example WHONET Clusters

| Clusters | Alert
Type | Recur
Interval | Start 
Date* | End 
Date* | Initial
Obs | Initial
Exp | Total
Obs | Total
Exp |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| S. marcescens | Abx Profile | 10,000 | 1/1/04 | 5/1/04 | 2 | 0.1 | 11 | 1.4 |
| S. aureus | Unit | 667 | 6/1/04 | 6/20/04 | 5 | 0.4 | 7 | 1.1 |
| E. faecalis | Service | 1,429 | 1/1/05 | 1/25/05 | 3 | 0.3 | 4 | 0.6 |
| A. baumannii | Hospital | 625 | 6/1/05 | 8/1/05 | 6 | 0.7 | 20 | 8 |

***Dates are fictitious**

- Confidential

## Acinetobacter baumannii Isolates

- Start date*: 6/1/05

- End date*: 8/1/05

***Dates are fictitious**

**Notes:**
Start date is the earliest start date associated with an acinetobacter cluster with a p-value of < or = 0.05.
End date is the latest end date associated with any overlapping acinetobacter cluster with a p-value of < or = 0.05

## Acinetobacter baumannii Clusters

| Clusters | Alert
Type | Recur
Interval | Start 
Date* | End 
Date* | Initial
Obs | Initial
Exp | Total
Obs | Total
Exp |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| A. baumannii | Hospital | 625 | 6/1/05 | 8/1/05 | 6 | 0.7 | 20 | 8.3 |
| A. baumannii | Unit | 2,000 | 6/1/05 | 7/10/05 | 3 | 0.3 | 4 | 0.6 |
| A. baumannii | Abx Profile | 10,000 | 6/1/05 | 7/28/05 | 6 | 1.7 | 15 | 7.5 |

***Dates are fictitious**

- Confidential

## Acinetobacter baumannii Suspicious Susceptibility Pattern

- Start*: 6/1/05

- End*: 7/28/05

- *Dates are fictitious

- Non-susceptible to 7 antibiotics:  Ampicillin, Cefotaxime, Ceftazidime, Levofloxacin, Nitrofurantoin, Gentamicin, Trimethoprim/Sulfamethoxazole

## BacLink 2Microbiology data conversion utility

- Many laboratories in the world have already computerized their microbiology laboratory systems
- This presents an obstacle and an opportunity

## WHONET

- Laboratory systems

- BacLink

- Excel
- Access
- EpiInfo

- Laboratory instruments

- Mysis
- MEDITECH
- ADBakt

- MIC systems
- Disk diffusion readers

- Data analysis

- Data conversion

## Susceptibility Test Instruments

- Microdilution systems
- 	ATB		Pasco		Vitek
- 	Mast Scan	Phoenix		Wider
- 	MIC 2000		Sceptor
- 	Microscan	Sensititre
- Disk diffusion readers
- 	Aura		SirScan
- 	Biomic		Videobac
- 	Mast Radius	Wider
- 	Osiris

## Laboratory Information Systems and Other Formats

- Laboratory Information Systems
- ADBakt (Sweden)		–   MEDITECH Client/Server*
- Cerner Classic		–   MEDITECH Magic
- Cerner Millenium*		–   MYSIS*
- MADS (Denmark)		–   Oman Laboratory Information System
- Medicom			–   WinPath
- Other formats
- CDC ELR format*		–   NARMS (United States)
- EARSS (European Union)	–   NORM (Norway)
- JIAQA (Japan)		–   WHO-AFRO Bacteriology Lab (Africa)
- * = In development