Upgrading automated susceptibility testing systems and data migration limits: Implications for infection control teams

Abstract

To the Editor: One of the primary responsibilities of a clinical microbiology laboratory is to ensure that the systems used to perform antibiotic susceptibility testing are current. As manufacturers develop new testing systems and upgrade existing systems, the services provided by the clinical microbiology laboratory are enhanced, ideally providing more reliable information to clinicians, epidemiologists, and pharmacists. In the process of negotiating an upgrade to our current automated susceptibility testing system, I perfunctorily asked whether my existing susceptibility data (approximately 12 years' worth of data) would be transferred to the new system. To my surprise, I was informed that I could migrate approximately 1 year's worth of susceptibility data at best, and that many customers who upgraded to the new system did not request transfer of any susceptibility data at all. It is difficult to understand how clinical microbiologists and epidemiologists can part with such critical information in the current climate of antibiotic resistance, temporal trending of susceptibility data, and the public pressure on epidemiologists to better understand and thwart the emergence and prevalence of resistance microorganisms.1Weber S.G. Huang S.S. Oriola S. Huskins W.C. Noskin G.A. Harriman K. et al.Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the joint SHEA and APIC task force.Am J Infect Control. 2007; 35: 73-85Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar Although some hospitals may use sophisticated epidemiologic software to those ends, the primary source of such analysis is derived largely from the susceptibility data in the laboratory in which the direct testing is done. From an epidemiologic perspective, historical susceptibility data is not simply a static repository of information or yesterday's news, but represents potential baseline data vis-à-vis anomalous findings that may not be recognized or articulated for some time—data that, in the current health care system, cannot easily be manipulated or recovered from a medical record or a secondary clinical system, which in most cases include only filtered susceptibility test results. Note that there is often a bidirectional interface between automated susceptibility equipment (ASE) and the laboratory information system (LIS). As such, complete (unfiltered) susceptibility data from the ASE could be archived in the LIS, assuming that an archival repository existed to capture this data in the LIS along with the desired query and reporting functions. However, many clinical microbiology departments do not have such a system at their disposal and rely almost exclusively on the ASE to generate periodic susceptibility reports and perform trending analyses. This is one reason why the Clinical Laboratory and Standards Institute presently recommends that clinical microbiology laboratories address the issue of primary data storage and the use of this stored data to identify and investigate emerging resistance trends over several years.2Clinical and Laboratory Standards Institute. Analysis and presentation of cumulative antimicrobial susceptibility test data: approved guidelines. 2nd ed. CLSI document M39–A2. Wayne (PA): Clinical and Laboratory Standards Institute.Google Scholar Losing access to historical susceptibility data after a system upgrade could in some cases lead to a gaping deficiency and limit the ability of microbiologists and infection control teams to study emerging resistance problems as their data are taken offline and literally out of the building. I suspect that a breach in communication between hospital microbiologists and epidemiologists can play a role in the loss of critically valuable susceptibility data. Before upgrading or replacing an existing testing system, microbiologists need to work with their epidemiology and infection control colleagues to determine what level of data migration (or data loss) is acceptable. For their part, manufacturers of susceptibility test systems need to recognize that historical susceptibility data, particularly institution-specific data, provide the baseline for current studies of antibiotic resistance over time as well as studies yet to be conceived, and need to devise effective methods for large-scale data transfer and storage in the development and evolution of their product lines.