title: Querying automated antibiotic susceptibility testing instruments: a novel population-based active surveillance method for multidrug-resistant gram-negative bacilli.
abstract: OBJECTIVE
  To describe the implementation of a population-based surveillance system for multidrug-resistant gram-negative bacilli (MDR-GNB).
  
  
  METHODS
  Population-based active surveillance by the Georgia Emerging Infections Program.
  
  
  METHODS
  Metropolitan Atlanta, starting November 2010.
  
  
  METHODS
  Residents with MDR-GNB isolated from urine or a normally sterile site culture.
  
  
  METHODS
  Surveillance was implemented in 3 phases: (1) surveying laboratory antibiotic susceptibility testing practices, (2) piloting surveillance to estimate the proportion of GNB that were MDR, and (3) maintaining ongoing active surveillance for carbapenem-nonsusceptible Enterobacteriaceae and Acinetobacter baumannii using the 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints. Pilot surveillance required developing and installing queries for GNB on the 3 types of automated testing instruments (ATIs), such as MicroScan, in Atlanta's clinical laboratories. Ongoing surveillance included establishing a process to extract data from ATIs consistently, review charts, manage data, and provide feedback to laboratories.
  
  
  RESULTS
  Output from laboratory information systems typically used for surveillance would not reliably capture the CLSI breakpoints, but queries developed for the 3 ATIs did. In November 2010, 0.9% of Enterobacteriaceae isolates and 35.7% of A. baumannii isolates from 21 laboratories were carbapenem nonsusceptible. Over a 5-month period, 82 Enterobacteriaceae and 59 A. baumannii were identified as carbapenem nonsusceptible.
  
  
  CONCLUSIONS
  Directly querying ATIs, a novel method of active surveillance for MDR-GNB, proved to be a reliable, sustainable, and accurate method that required moderate initial investment and modest maintenance. Ongoing surveillance is critical to assess the burden of and changes in MDR-GNB to inform prevention efforts.
authors.affiliation: Atlanta Research and Education Foundation, Decatur, Georgia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Reno
authors.forename: Calista
authors.initials: C
authors.lastname: Schenck
authors.forename: Janine
authors.initials: J
authors.lastname: Scott
authors.forename: Leigh Ann
authors.initials: LA
authors.lastname: Clark
authors.forename: Yun F Wayne
authors.initials: YF
authors.lastname: Wang
authors.forename: Susan
authors.initials: S
authors.lastname: Ray
authors.forename: Paula Snippes
authors.initials: PS
authors.lastname: Vagnone
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Jacob
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D057205:Automation, Laboratory; D024901:Drug Resistance, Multiple, Bacterial; D005845:Georgia; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000295:instrumentation*; D011159:Population Surveillance / Q000379:methods*; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents