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Uses of a microcomputer in microbiology.

Most of our hospital's laboratory work is on a mainframe computer. All of our chemistry and hematology data, for example, are entered into and reported by this system. Microbiology is not.

As a recent MLO article pointed out, microbiology tends to have far more complex requirements for computerization than the other lab disciplines; consequently there has been a dearth of appropriate commercial software in our area. Our own investigations, during a recent search for an updated laboratory computer system, suggest that several companies are making progress toward meeting microbiology's needs. Meanwhile, we have found several uses of a microcomputer in microbiology that we would like t share with you.

About two years ago, our lab acquired a microcomputer, initially with the intention of using it to keep track of quality control results in chemistry. Additionally, we thought we might be able to use it in the microbiology lab to interpret minimum inhibitory concentration (MIC) results, which until then were being done manually by the head of the section or by one of the pathologists.

Eventually, we managed to move the microcomputer, an Apple IIe, into microbiology. We have found multiple uses for it, four of which we would like to describe here. (In the June 1985 issue of MLO, we presented other applications in microbiology.)

The first problem we faced was learning how to write a program. With no experience or knowledge, this meant going to a tutorial and learning how to write programs in BASIC. As anyone who has tried this approach knows, it also meant many hours of frustration during the early stages of program writing.

Our first program was a very simple one. It enables us to calculate a specific dosage of an aminoglycoside based on a patient's weight and estimated creatinine clearance. From this simple program, we evolve software that now furnishes what we call an "Aminoglycoside Dosage Schedule." We take into account the patient's age, weight, height, and sex in arriving at an ideal body weight, a dosing weight, and an estimated creatinine clearance. The program is able to calculate the suggested dosage of the four most commonly used aminoglycosides, i.e., gentamicin, tobramycin, kanamycin, and amikacin, and a printout can be furnished to the physician in less than five minutes with suggested dosages based on the patient's creatinine value (see Figure I).

Our second endeavor was a little more challenging. It is our belief that MIC results are of limited value unless the results can be equated with teh achievable concentrations at the site from which the organism was either isolated or, in the case of a bacteremia, the site believe to be the actual focus of infection, e. g., bone in the case of osteomyelitis or the lungs in cases of pneumonia. We therefore do not report MICs for most of our bacterial isolates but do so automatically for organisms isolated from blood or cerebrospinal fluid. We also furnish MIC results upon request when a physician is dealing with an infection that is proving difficult to treat, as when the organism is highly resistant or penetration of specific antimicrobial agents into the area of the infection tends to be poor.

When MIC interpretations were reported in the past, they were done manually, consumed a great deal of time, and tended to reflect biases based on the patient's conditions, present antibiotic therapy, and the individual actually doing the interpreting. We felt that this was unacceptable and that our microcomputer could overcome all of these problems. We chose to modify and expand a program written by Daniel J. Fink, M.D., described in a JAMA article.

Our user-friendly program permits any one of our technologists to enter all of the necessary data and get a printout of the interpretations based on the site or sites of infection (see Figure II). We have included a space for comments to the physician but also have built in several automatic comments, such as, "This isolate is beta-lactamase positive and should be considered ampicillin-resistant" (when a Haemophilus influenzae isolate is beta-lactamase positive), or "Cephalothin results may not be reliable if the isolate is resistant to methicillin. The possibility of cephalothin resistance should be considered" (when a Staphylococcus species is resistant to methicillin). The end of the program even furnishes us with a charge slip that is sent to the accounting office for billing purposes.

An article in MLO a few years ago suggested that accession logs for microbiology could be streamlined in many labs because far more information was included than was necessary. We adopted this suggestion and changed our form radically, thereby saving a lot of technologist time entering and transcribing information from the requisition forms received from the nursing stations and the finished reports leaving our lab.

We have now taken this a step further. Our third use of the computer has moved our accession log into the computer age. This time, however, we had commercial software available from which to build the logs, and the task proved to be far easier than trying to write our own program.

We chose the Quick File II software program for logging in our specimens and now have the ability to call up information readily on the CRT terminal. In the past, when we got a request as to the status of a specimen, we had to go to the handwritten log for that day and find the patient's name on one of the pages (which included trying to decipher several different technologists' handwriting). Then we could discover the specimen number and check to see whether the culture was completed or check the worksheet for that culture.

Now we arrange our logs in alphabetical order of the patients' last names, making it much easier and faster to determine the specimen number and present status. We also added the time of collection t the log since we accept certain multiple specimens, e.g., stools, only at specified intervals. We used to keep a separate sheet for this information, but now it is all readily available on one neat printout easily read by anyone (see Figure III).

Our microcomputer also serves other purposes in microbiology. We have used the Quick File II program, for example, to catalog all of the CAP proficiency test organisms we have received in the different sections of microbiology and parasitology. We enter the name of the organism, the year(s) it was given, and the specimen number, e.g., F-9. We update the file each time we receive the CAP critiques and keep the file in the same book in which the reports themselves are kept. Now when we are faced with a difficult organism we think we've seen in a survey, we can readily find it by reference to our alphabetically listed sheets and try to find clues to help us correctly identify clinical specimens.

We have used the filing system to collect and arrange data for other hospital-related studies such as a recent audit for our Pharmacy and Therapeutics Committee dealing with antibiotic usage in patients with urinary tract infections. In that study we monitored urinalysis results from our mainframe computer and collated them with results from urine cultures done by the microbiology department. We were then able to set limits as to the information we required, and the computer culled these data based on the parameters we specified.

Earlier I mentioned that we would describe four different functions for our microcomputer, but I've only specifically presented three. The fourth one, however, is what permitted the writing and editing of this article; you see, this was done using our computer as a word processor.
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Author:Manasse, Robert J.
Publication:Medical Laboratory Observer
Date:Sep 1, 1985
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