ViResiST

Electronic Microbiological Form and Dynamic Empirical Guideline

The ViResiST Project

ViResiST

• The treatment of bacterial infections must be based on the infecting microorganism and on its resistance to available antibiotics.

• These two facts are difficult to be established at the initial contact between clinician and patient.

• Empirical guidelines based on local epidemiology can propose effective treatments but infecting microorganisms as well as susceptibility patterns can vary with time.

• Therefore, it is necessary to be able to capture this local and changing scenario. The ViResiST project (www.viresist.org) provides the necessary data as well as the appropriate methodological tools for this objective.

ViResiST

• We constructed an Electronic Microbiological Form in order to guide the clinician to the most appropriate test at the same time he must signal the syndrome (or clinical situation)

• Immediately the system show the recommended antibiotics (for this syndrome) based on more likely microorganisms as well as on expected resistance (calculated via Time Series Analysis models)

ViResiST

Clinician dataClinician data

Patient data

Sample data

Infection data

Electronic Microbiological Form

ViResiST

First step: selecting the infection

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Several possibilities

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We select Urinary Tract Infection

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Selecting syndrom (clinical situation)

ViResiST

Several possibilities for Urinary Tract Infections

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We select acute pyelonephritis

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We select other patient circumstances (Antecedentes)

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(No special circumstances for pyelonephritis): indeterminado

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Immediately a pop-up, automatically appears with recommended antibiotic

ViResiST

First Choice Second ChoiceComments

A detailed guideline is showed for acute pyelonephritis

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Clicking the ViResiST link

Most likely microorganism

ViResiST

In a pop-up, the most frequent microorganism in pyelonefritis patients (until 80%) is showed, as well as the predicted resistance for current

month. In this example: Escherichia coli is expected by a 84,4%

ViResiST

cystitis

54.5 + 10.8 + 8.7 + 8.2 = 82.2 %

In this other example, expected microorganisms for cystitis is showed (until, at least, a 80% probability)

ViResiST

Comments

• Most likely microorganism is calculated from already existing information based on local epidemiology.

• The offered information (likely microorganism and expected resistance) allows Infection Committee to elaborate more accurate empirical recommendations, adapted to local reality

• Recommended antibiotic depends not only of expected resistance but also of its impact on local resistance

• All data is periodically and automatically updated

ViResiST

Selecting sample

Selecting sample

The Electronic Microbiological form, also guides clinician to the most appropiate microbiological test for his patient

ViResiST

Urine culture

Suprapubic punction

Blood culture

Sugested samples are showed

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General culture

Fungi culture

Selecting a sample (urine in this example), appropriated tests are showed

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Comments

• Signaling a syndrome is mandatory, that will assure to have clinical information for the microbiological isolate.

• Clinician is informed about available determinations in the local laboratory.

• Clinician is guided about recommended samples for every clinical situation

ViResiST

At the end, the request is sent to the Microbiology system