Program Schedule

Parsing Multi-Source Microbiology Culture Data in a Regional Health Information Exchange to Describe Patterns of Infection

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: In consultation with infection preventionists (IPs), we built an electronic system to parse Health Level 7 version 2 (HL7v2) messages for microbiology culture data sent to a regional health information exchange.  The primary purpose of that system was to enable a regional network to deliver alerts when a patient with a history of gram negative rod multi-drug resistant organism (GNRMDRO) is admitted to an emergency department (ED) or hospital.  A separate abstract describes the first 12 weeks of GNRMDRO alerts.  In building that system, we sought to parse all inbound microbiology culture data (for susceptible as well as resistant organisms), in order to be able to describe bacterial infections and antibiograms across a wide region (27 hospitals).  Here we report the results of an initial test of this aspect of the system, for infants 0 to 91 days old.

Methods: We built 1) an HL7v2 correction engine that deals with incorrect microbiology message structure and content.  The HL7v2 correction engine parses key data elements needed for epidemiologic analyses:  organism, antibiotics tested, minimum inhibitory concentrations, susceptibility interpretation, body source of the culture, and health care facility where drawn.  We describe blood and/or urine cultures, for infants 0 to 91 days old, from the first 20 weeks of the new system to parse electronic microbiology culture data.

Results: Seventy-eight infants (42 girls, 36 boys) had at least one positive culture for one or more GNRs (64 urine, 9 blood, 5 infants with both).  The majority of the results were Escherichia coli (54%), followed by Klebsiella pneumoniae (15%), Enterobacter cloacae (10%), Klebsiella oxytoca (6%), and various others.  The age range of the 78 infants was 0 to 91 days.  Three of the 78 infants had urine cultures identified as Enterobacteriaceae with extended-spectrum beta lactamase (ESBL-E), two with Escherichia coli and one with Klebsiella pneumoniae.  One of these three had a first urine culture that was a GNR but not ESBL-E, followed by a urine culture of ESBL-E three weeks later.

Conclusion: This electronic microbiology parsing system shows promise, in a health information exchange, for describing infection and antibiotic resistance patterns across a region.  Most patients with GNRMDRO are adults, but the system is also useful for pediatric data.

Marc Rosenman, MD1, Kinga Szucs, MD1, S. Maria E. Finnell, MD, MS1, Shahid Khokhar2 and Abel Kho, MD3, (1)Pediatrics, Indiana University School of Medicine, Indianapolis, IN, (2)Regenstrief Institute, Indianapolis, IN, (3)Feinberg School of Medicine, Northwestern University, Chicago, IL


M. Rosenman, None

K. Szucs, None

S. M. E. Finnell, None

S. Khokhar, None

A. Kho, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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