BACKGROUND: Antibiotic resistance is a growing public health problem which threatens to increase in severity in the coming years. Public health is increasingly involved in addressing this issue. A cornerstone of prevention is the establishment of surveillance and tracking systems to enable timely, and when needed emergency response.
METHODS: Nebraska DHHS Epidemiology established antibiotic resistance as a priority and in 2010 mandated via reportable disease regulations the reporting of antibiograms for four species in its reportable disease system. For the past 6 years, all laboratories who utilize automated electronic lab reporting (ELR) for reportable disease reporting were required to submit all isolates of Staphylococcus aureus, Enterococcus spp., Klebsiella spp., and Acinetobacter spp., by automated electronic lab report to include the complete antibiograms (MICs and interpretations). During that time period, a total of 15 laboratories were on boarded and are currently reporting isolate-specific antibiotic susceptibility data.
RESULTS: This presentation addresses the technical, logistic, and epidemiologic methods and challenges in establishing an isolate-specific antibiotic susceptibility tracking system as a component of a statewide reportable disease program. In particular, we discuss regulatory language, HL7 formatting issues, data volume and storage issues, processing the data to derive useful epidemiologic datamarts, and data validation.
CONCLUSIONS: Antibiotic resistance surveillance through utilization of existing reportable disease infrastructure is a viable approach to tracking population-wide antibiotic resistance. While staff and information technology resources are required, the existing implementation guides and interface/hardware/software infrastructure offer economies.