WHONET DOCUMENTATION IN ANTIBIOTIC POLICY

Dr.T.V.Rao MD Antibiotics are considered as strength of the Modern Medicine, and helped the humans to progress

to the present stage, along with several other advances in Medicine. At present, the Antibiotics are

used for needy patients and misused too when there is no need for an antibiotic prescription. Drug

resistance develops naturally, but careless practices in drug supply and use are hastening it

unnecessarily, we certainly need a system to document the results of antibiotic sensitivity and

resistance patterns arising in our Institution, It is crucial to monitor emerging trends in resistance at

the local level to support clinical decision making, infection-control interventions, and antimicrobial-

resistance containment strategies. Monitoring of antimicrobial resistance trends is commonly

performed in health care facilities using an annual summary of susceptibility rates, known as a

cumulative antibiogram report which can be documented with WHONET. However we are aware

that we have no documented protocols in India on making an antibiotic policy. At this hour WHONET

guides on many matters on happenings in our health care area on trends of Antibiotic sensitivity and

resistance patterns.

WHAT IS WHONET - WHONET is free Windows-based database software developed for the

management and analysis of microbiology laboratory data with a special focus on the analysis of

antimicrobial susceptibility test results. These tools enable microbiology laboratories to put its test

results into a database and conduct analysis to support local infection control and antibiotic usage at

our Hospital

The software has been developed since 1989 by the WHO Collaborating Centre for Surveillance of

Antimicrobial Resistance based at the Brigham and Women's Hospital in Boston, and is used by

clinical, public health, veterinary, and food laboratories in over 90 countries to support local and

national surveillance programs.

Laboratories can also upload files created by WHONET, to feed into national or other multi-centre

surveillance networks and to strengthen our Drug policy. Such surveillance programs are now in

place in many countries and part of Accreditation standards in our country.

How we can Progress with WHONET

We can enhance the local data for local needs: clinical decision support, antimicrobial use policy,

infection control and outbreak detection, identifying laboratory test performance, and

characterization of local microbial and resistance epidemiology

And to promote local, national, regional, and global collaborations through the exchange of data and

sharing of experiences.

The WHONET experience suggests that pattern of drug resistance data can be collected and

analysed in resource- constrained settings, using core microbiology, if local laboratories are given

appropriate support. Strengthening these laboratories is therefore a potentially cost-effective

Contribution to both treating drug resistant disease and preventing its further spread.

Microbiologists, Clinicians and Infection control workers may use its software to enhance monitoring

of drug resistance in their hospitals and communities and to merge their files into national, regional,

and global networks for surveillance of drug resistance.

WHONET can also analyse stored data. From a single screen, a WHONET user selects the type of

analysis to run, the species of bacteria to analyse, the subsets of isolates to include e.g., all, isolates

from urine, blood, and isolates resistant to Cephalosporin’s, Carbapenems or any other drug

individually and from certain locations in outpatients and any wards like ICCU’s Medicine, Surgery or

any other speciality areas

Every patient in our Hospital or its community carries a complex bacterial ecosystem and each

patient care unit within the centre and ultimately the centre itself may be seen as an aggregated

ecosystem. Resistance genes and the strains they make resistant move through these systems,

selectively accelerated by specific antimicrobial agents given to specific patient’s and retarded by

infection control practices. Both strategic and day-to-day management of those practices and of the

selection of those agents need optimal, current information about the linkages of the resistance

genes and the deployment of the strains. The Microbiology laboratory at our Hospital also needs

continuing analysis of its susceptibility test and quality control results. Each laboratory tests

hundreds of different combinations of bacterial species and antimicrobial agents. Variations in the

usual distributions of measurements for any of the combinations, and particularly of those that

impinge upon breakpoints may signal either problems in test performance or new types of

resistance.

Consensus guidelines have been developed by the CLSI to standardise methods used in constructing

antibiograms, with the goal of promoting the reporting of reliable and consistent antibiogram data.

The current guideline is CLSI M39-A3, entitled "Analysis and Presentation of Cumulative

Antimicrobial Susceptibility Test Data". The salient points of this document include the following.

•The data should be analysed annually. However, if there are a large number of isolates, this may be

done six monthly or more frequently.

•At least 30 isolates should be present for inclusion in the analysis.

•The isolates that are obtained from diagnostic testing should only be included and those from

surveillance cultures, e.g., MRSA screening should not be included. Colonisers should not be

included.

•Include results for the antibiotics that are routinely tested.

•Only the first isolate from a patient irrespective of the specimen site should be included.

•The cumulative antibiogram should present only the percentage susceptible and not those which

are intermediate susceptible.

•It is useful to stratify the antibiogram into outpatient, inpatient and ICU

A present WHONET helps Hospitals Creates profile of the Bacterial Infections at our Hospital.

Helps to know the Antibiograms pattern of the different isolates. Trends in MRSA, and patterns of

drug resistance in several Gram negative bacterial strains.

We can alert the physicians on uncommon, clinically important bacterial pathogens.

Helps our faculty to present data at academic associations and in publishing papers as per editorial

guidelines.

However it needs greater cooperation of all Clinicians to build the system to our Hospital needs,

The protocols can be integrated into the Antibiotic policy and policy decisions can be

taken going through audited results from WHONET documentation

References 1 Hospital antibiogram: S Joshi necessity Department of Microbiology, Manipal Hospital,

98 Rustom Bagh, HAL Airport Road, Bangalore - 560 017, India

2 Clinical and Laboratory Standards Institute (CLSI). Analysis and presentation of cumulative

antimicrobial susceptibility test data. 3rd ed. Approved guideline M39-A3. Wayne PA. CLSI, 2009.

3Hindler JF, Stelling J. Analysis and presentation of cumulative antibiograms: A new consensus

guideline from the Clinical and Laboratory Standards Institute. Clin Infect Dis 2007; 44:867-73

Dr.T.V.Rao MD Professor of Microbiology Freelance writer