Electronic microbiological form and dynamic empirical guideline based on ViResiST project (www.viresist.org)

1. Electronic Microbiological Form
and Dynamic Empirical Guideline
The ViResiST Project
ViResiST

2. • 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

3. • 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

4. Electronic Microbiological Form
Clinician data
Clinician data
Patient data
Sample data
Infection data
ViResiST

5. First step: selecting the infection
ViResiST

6. Several possibilities
ViResiST

7. We select Urinary Tract Infection
ViResiST

8. Selecting syndrom (clinical situation)
ViResiST

9. Several possibilities for Urinary Tract
Infections
ViResiST

10. We select acute pyelonephritis
ViResiST

11. We select other patient
circumstances (Antecedentes)
ViResiST

12. (No special circumstances for
pyelonephritis): indeterminado
ViResiST

13. Immediately a pop-up, automatically
appears with recommended antibiotic
ViResiST

14. A detailed guideline is showed for acute
pyelonephritis
First Choice Second Choice
Comments
ViResiST

15. Most likely microorganism
Clicking the ViResiST link
ViResiST

16. 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

17. In this other example, expected microorganisms for
cystitis is showed (until, at least, a 80% probability)
cystitis
ViResiST
54.5 + 10.8 + 8.7 + 8.2 = 82.2 %

18. 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

19. The Electronic Microbiological form, also guides clinician to
the most appropiate microbiological test for his patient
Selecting sample
Selecting sample
ViResiST

20. Sugested samples are showed
Urine culture
Suprapubic punction
Blood culture
ViResiST

21. Selecting a sample (urine in this example),
appropriated tests are showed
General culture
Fungi culture
ViResiST

22. 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

23. At the end, the request is sent to the
Microbiology system
ViResiST