1. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

2. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

3. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

4. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

5. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

6. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

7. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

8. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Isolate listing: List of patients with MRSA

9. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Isolate Summary: Number of patients with MRSA by location and month

10. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston %RIS and histograms: Pseudomonas aeruginosa

11. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Scatterplot - Klebsiella pneumoniae Amikacin vs. Gentamicin

12. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Staphylococcus aureus Total and by Resistance Profile

13. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston BacTrack Expert System Isolate alerts

14. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Example WHONET Clusters ClustersAlert Type Recur Interval Start Date* End Date* Initial Obs Initial Exp Total Obs Total Exp S. marcescens Abx Profile 10,0001/1/045/1/0420.1111.4 S. aureus Unit6676/1/046/20/0450.471.1 E. faecalis Service1,4291/1/051/25/0530.340.6 A. baumannii Hospital6256/1/058/1/0560.7208 *Dates are fictitious Confidential

15. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Acinetobacter baumannii Isolates Start date*: 6/1/05End date*: 8/1/05 *Dates are fictitious

16. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Acinetobacter baumannii Clusters ClustersAlert Type Recur Interval Start Date* End Date* Initial Obs Initial Exp Total Obs Total Exp A. baumannii Hospital6256/1/058/1/0560.7208.3 A. baumannii Unit2,0006/1/057/10/0530.340.6 A. baumannii Abx Profile 10,0006/1/057/28/0561.7157.5 *Dates are fictitious Confidential

17. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Acinetobacter baumannii Suspicious Susceptibility Pattern Start*: 6/1/05End*: 7/28/05 *Dates are fictitious Non-susceptible to 7 antibiotics: Ampicillin, Cefotaxime, Ceftazidime, Levofloxacin, Nitrofurantoin, Gentamicin, Trimethoprim/Sulfamethoxazole

18. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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

19. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Desktop softwaresLaboratory systems WHONET BacLink Excel Access EpiInfo Laboratory instruments Mysis MEDITECH ADBakt MIC systems Disk diffusion readers Data analysis Data conversion

20. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston Susceptibility Test Instruments Microdilution systems ATBPascoVitek Mast ScanPhoenixWider MIC 2000Sceptor MicroscanSensititre Disk diffusion readers AuraSirScan BiomicVideobac Mast RadiusWider Osiris

21. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance Brigham and Women’s Hospital, Boston 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