MDRO Surveillance Help

Overview

The MDRO Surveillance module automatically detects and tracks Multi-Drug Resistant Organisms from microbiology culture results. It provides real-time surveillance for Infection Prevention teams and feeds case data to the Outbreak Detection module for cluster analysis.

Key Features

Automated Detection - Classifies organisms as MDRO based on susceptibility patterns
Transmission Tracking - Categorizes cases as healthcare-onset or community-onset
Case Management - IP review workflow for each case
Analytics - Trend analysis by MDRO type, unit, and time period
Integration - Exports cases to Outbreak Detection for cluster analysis

MDRO Classification Criteria

Classification follows CDC/NHSN definitions for consistency between real-time surveillance and quarterly NHSN AR reporting.

MDRO Type	Full Name	Organisms	Resistance Criteria
MRSA	Methicillin-resistant Staphylococcus aureus	S. aureus	Oxacillin R, Methicillin R, Nafcillin R, or Cefoxitin R
VRE	Vancomycin-resistant Enterococcus	E. faecalis, E. faecium	Vancomycin R
CRE	Carbapenem-resistant Enterobacterales	E. coli, Klebsiella, Enterobacter, Citrobacter, Serratia, Proteus, etc.	Meropenem R, Imipenem R, Ertapenem R, or Doripenem R
ESBL	Extended-spectrum Beta-lactamase	E. coli, Klebsiella spp, P. mirabilis	Ceftriaxone R, Ceftazidime R, Cefotaxime R, or Aztreonam R
CRPA	Carbapenem-resistant Pseudomonas aeruginosa	P. aeruginosa	Meropenem R, Imipenem R, or Doripenem R
CRAB	Carbapenem-resistant Acinetobacter baumannii	A. baumannii	Meropenem R, Imipenem R, or Doripenem R

Note: CRE classification takes precedence over ESBL. If an organism is resistant to carbapenems, it is classified as CRE rather than ESBL.

Transmission Classification

Cases are classified based on time from hospital admission to culture collection:

Classification	Definition	IP Implications
Community Onset	Culture collected ≤48 hours after admission	Patient arrived with MDRO; focus on screening and isolation protocols
Healthcare Onset	Culture collected >48 hours after admission	Possible hospital acquisition; investigate potential transmission and environmental factors

Quick Start - Generate Demo Data

Create MDRO Cases

Generate demo patients with various MDRO scenarios:

# Create a random MDRO case
cd /home/david/projects/aegis
python scripts/demo_mdro.py

# Create a specific MDRO type
python scripts/demo_mdro.py --scenario mrsa
python scripts/demo_mdro.py --scenario vre
python scripts/demo_mdro.py --scenario cre
python scripts/demo_mdro.py --scenario esbl
python scripts/demo_mdro.py --scenario crpa
python scripts/demo_mdro.py --scenario crab

# Specify onset type
python scripts/demo_mdro.py --scenario mrsa --onset healthcare
python scripts/demo_mdro.py --scenario mrsa --onset community

# Shorthand for community-onset
python scripts/demo_mdro.py --scenario mrsa --community

# Specify unit
python scripts/demo_mdro.py --scenario mrsa --unit "ICU-A"

# Create all scenario types
python scripts/demo_mdro.py --all

Run the MDRO Monitor

After creating demo data, run the monitor to detect MDRO cases:

# Run once
cd /home/david/projects/aegis/mdro-surveillance
python -m mdro_src.runner --once

# Run with extended lookback
python -m mdro_src.runner --once --hours 72

# Run continuously
python -m mdro_src.runner --continuous --interval 30

# Debug mode
python -m mdro_src.runner --once --debug

Then view results on the MDRO Dashboard.

Demo Scenarios

Scenario	Command	Organism	Key Resistance
MRSA	`--scenario mrsa`	Staphylococcus aureus	Oxacillin R, Cefoxitin R
VRE	`--scenario vre`	Enterococcus faecium	Vancomycin R
CRE	`--scenario cre`	Klebsiella pneumoniae	Meropenem R, Ertapenem R
ESBL	`--scenario esbl`	Escherichia coli	Ceftriaxone R, Ceftazidime R
CRPA	`--scenario crpa`	Pseudomonas aeruginosa	Meropenem R, Imipenem R
CRAB	`--scenario crab`	Acinetobacter baumannii	Meropenem R, Imipenem R

IP Case Review Workflow

When reviewing an MDRO case, the Infection Preventionist can:

View Case Details - Patient info, organism, susceptibilities, unit, culture date
Check Transmission Status - Verify community vs healthcare onset classification
Review Prior Cases - See patient's previous MDRO history
Add Review Notes - Document investigation findings and actions taken
Mark Decision - Confirm case, request follow-up, or close as resolved

Review Decisions

Confirmed - Case verified as MDRO, proceed with IP protocols
Needs Investigation - Additional review needed (contact precautions, environmental assessment)
Resolved - Case closed, no further action needed

Integration with Outbreak Detection

MDRO cases are automatically exported to the Outbreak Detection module for cluster analysis.

Data Flow

MDRO Surveillance                    Outbreak Detection
+------------------+                 +------------------+
| Culture Results  |                 | MDROSource       |
| (FHIR Server)    |                 | (Data Adapter)   |
+--------+---------+                 +--------+---------+
         |                                    |
         v                                    v
+------------------+    API Export   +------------------+
| MDRO Classifier  +---------------->| Cluster Detector |
| (CDC/NHSN Rules) |                 | (Time + Unit)    |
+--------+---------+                 +--------+---------+
         |                                    |
         v                                    v
+------------------+                 +------------------+
| MDRO Cases DB    |                 | Outbreak Alerts  |
| (SQLite)         |                 | (IP Notification)|
+------------------+                 +------------------+

API Export

Cases can be exported programmatically:

GET /mdro-surveillance/api/export?days=14

Returns JSON with case details for clustering analysis.

Dashboard Pages

Page	URL	Description
Dashboard	/mdro-surveillance/	Overview with stats, recent cases, and MDRO type breakdown
Cases	/mdro-surveillance/cases	All cases with filtering by type, unit, and time period
Analytics	/mdro-surveillance/analytics	Trend analysis and reporting charts
Help	/mdro-surveillance/help	This page

Troubleshooting

FHIR server not responding

# Check if HAPI FHIR container is running
docker ps | grep hapi

# Restart if needed
cd asp-bacteremia-alerts
docker-compose down && docker-compose up -d

Clear MDRO data and start fresh

# Remove MDRO database
rm -f ~/.aegis/mdro.db

# Clear FHIR server data
cd asp-bacteremia-alerts
docker-compose down && docker-compose up -d

Check database contents

sqlite3 ~/.aegis/mdro.db "SELECT mdro_type, COUNT(*) FROM mdro_cases GROUP BY mdro_type"

Related Modules

Outbreak Detection - Cluster detection and investigation
HAI Detection - Healthcare-associated infection surveillance
NHSN AR Reporting - Quarterly antimicrobial resistance reporting
Drug-Bug Mismatch - Therapy coverage alerts

MDRO Surveillance - Help & Demo Guide