Drug-Resistant

The implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, permits health departments with the authority to establish programs to improve health care quality by the promotion of health IT and includes guidelines for receiving and transmitting secure electronic health information. When ELR health data has been verified for completeness, it enhances the ability to monitor HIV diagnosed patients for virologic failure that in some cases is associated with ADR. In recent years the transmission of HIV drug-resistant strains among persons with HIV has been an on-going concern. When drug-resistant HIV becomes resistance to more than one drug class, the control of viral replication becomes more difficult. Consequently, measuring the burden of antiretroviral resistance has risen in importance, ranking alongside other major public health concerns when planning HIV prevention campaigns. The analytical method illustrated here aims to improve monitoring of patients with increased viral replication that may lead to poor clinical outcomes and resistance to antiretroviral medications, leading to significant increases in monetary costs when prescriptions for secondline drug regiments are required.

Objective

The aim of this presentation is to illustrate a public health surveillance method for monitoring antiretroviral drug resistance (ADR) in persons diagnosed with human immunodeficiency virus infection (HIV). We developed procedures for examining HIV related electronic laboratory reports (ELR) transmitted to our health department surveillance system that link to corresponding clinical and demographic data for patients with varying degrees of antiretroviral drug resistance.

CRE are drug-resistant bacteria that have a mortality rate of up to 50% in those infected. Several clusters of CRE have been detected in Illinois, often in long-term acute care hospitals. In response, Illinois created the XDRO registry, a mandatory reporting system designed to aid inter-facility communication concerning CRE.

Despite being a high priority for control in the US, the case definition for CRE has been the subject of debate3. There are over 70 Enterobacteriaceae which can have different mechanisms of carbapenem resistance. Criteria for carbapenem resistance include susceptibility results and phenotypic or genotypic detection. The case definition for the XDRO registry is intentionally more exclusive (specific) than that used by CSTE (Table 1). CSTE utilizes a definition designed to maximize sensitivity. Illinois’ XDRO registry’s definition is more specific, meant to reduce unnecessary adoption of contact precautions and the negative consequences some patients may experience.

Currently, case reporting to the XDRO registry is a manual data entry process, which has important advantages. However, transitioning to automatic ELR integration will streamline the reporting process and minimize data entry effort. Unfortunately, the clinical information needed to investigate XDROs is often not captured by ELR. The eCR is a new message type being piloted in Illinois that contains many clinical data elements. We examined the feasibility of combining ELR and eCR into reports for the XDRO registry. In the construction of these reports, we examined the impact of using CRE definitions from CSTE and the XDRO registry. 

Objective

To streamline carbapenem-resistant enterobacteriaceae (CRE) surveillance by integrating electronic laboratory reporting (ELR) data and electronic case reports (eCR) automatically into Illinois’ extensively drug-resistant organism (XDRO) registry.