{"aaData": [["MRSA", "
Methicillin-resistant Staphylococcus aureus
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\nMethicillin (or oxacillin)-resistant Staphylococcus aureus (MRSA) is a \ntransmission amplifies the number of patients who may become colonized and\nwho are then at risk for clinical infection.\n \nIt is important to capture all positive tests for MRSA, both clinical \ncultures and surveillance screening tests (e.g., nares screens). Any \nStaphylococcus aureus isolate that is resistant to Methicillin (or \noxacillin) should be captured for this. VHA Laboratory Service must record\nresults of MRSA tests performed using the following methodology:\n \n   1. MI-subscripted tests will be used for clinical cultures (C&S)       \npathogen of continuing importance for healthcare facilities. It is a \nonly. STAPHYLOCOCCUS AUREUS METHICILLIN RESISTANT (MRSA) is the only\n      etiology that will be used to report positive clinical cultures.  \n \n   2. CH-subscripted tests will be used for MRSA nares screens or MRSA\n      surveillance cultures. Laboratory is required to use the following\n      test names: MRSA SURVL NARES DNA, MRSAL SURVL OTHER DNA, MRSA SURVL\n      NARES AGAR, MRSA SURVL OTHER AGAR.\n \nPlease refer to the "Laboratory Reporting of MRSA Test" for information on\nhow to setup the standardized test names and etiology.\nGram-positive coccus that can be resistant to multiple antibiotics, causes\n \nNOTE: Adding Methicillin-resistant Staphylococcus aureus to the MDRO Tools\nLab Parameter Setup is mandatory. The above standards for MRSA laboratory\nreporting (clinical cultures and screening tests) have been hard coded\ninto the MDRO Program Tools software, and does not need to be entered into\nthe MDRO lab parameters setup. Only historical methods of reporting, that\nwere different from the national standards need to be entered. The purpose\nof adding this pathogen to the parameter set-up is to identify prior\nhistory of MRSA (either by clinical culture or nares screen) based on\nlaboratory reporting. If the facility fails to use the laboratory\nserious disease, and is often difficult to treat. It is the cause of\nstandards set forth, the program will be unable to generate accurate\nreports for data reporting.\nhealthcare-associated infections (HAIs), and is an emerging pathogen from\ncommunity-associate sources. MRSA can be cultured from the nares and other\nsites in patients who are colonized or infected with the organism. It is\ntransmitted, in general, by contact, with the hands of patients or health\ncare workers or inanimate objects contaminated with MRSA. Such\n
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Carbapenem-resistance
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\nCarbapenems are a class of beta-lactam antibiotics with a broad spectrum \npatient's current or prior history of CRE based on laboratory reporting \nand the time frames that are entered to search for the patient's status. \nThe result must occur as a CRE bacterial etiology and any result \ncontained in a "Free-Text" section will not allow incorporation of the \nCRE into the MDRO Program Tools software.  Refer to the  "VistA Lab \nEnhancements (VLE) - Microbiology User Guide" for instructions to \nconfigure the MDRO Tools Lab Parameter Setup to properly run the CRE \nReport.\nof antibacterial activity. These agents have the broadest antibacterial \nspectrum compared to other beta-lactam classes. They are active against \nboth Gram positive and Gram negative bacteria, and can be used to treat \nnosocomial and mixed bacterial infections. Resistance to carbapenems is of\nimportance because it limits therapeutic options.\n \nNOTE: The purpose of adding carbapenem-resistant enterobacteriaceae (CRE) \netiologies to the MDRO Tools Lab Parameter Setup is to identify a \n
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Vancomycin-Resistant Enterococcus
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\nVancomycin-resistant Enterococcus (VRE) is a pathogen of increasing \nparameter set-up is to identify a patient's current or prior history of \nVRE based on laboratory reporting and the time frames that are entered to \nsearch for the patient's status. This information can optionally be \ndisplayed on the Isolation Report. This includes cultures positive for \nprevalence and surveillance review, including specimens of stool and \nrectal swabs. It is important to search for all vancomycin resistant \nenterococci, whether speciated or not. It is important to be sure to list\nall the places in the Microbiology Laboratory package where Enterococcus\nare found, either as Enterococcus, E. (sp.), Group D-Streptococcus, E.\nfaecalis, E. faecium, E. durans, E. gallinarum, E. casseliflavus, etc.  \nimportance for healthcare facilities. Enterococcus is a bacterium that \nThe laboratory parameter setup for the MDRO Program Tools should match the\nsame parameter setup for the EPI (Emerging Pathogens Initiative). If\nchanges are made to how Vancomycin-resistant Enterococcus is reported it\nshould also be changed in EPI parameter setup.\nlives in the intestinal tract and in the female genital tract. Vancomycin\nis an antibiotic that is often used to treat infections caused by\nenterococci, and recently enterococci have become resistant to this drug.\nMost VRE infections occur in the hospital.  \n \nNOTE: Adding Vancomycin-resistant Enterococcus to the MDRO Tools Lab \nParameter Setup is optional. The purpose of adding this pathogen to the \n
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Clostridium difficile
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\nClostridium difficile is a species of gram-positive bacteria. The disease\npresence of Clostridium difficile.\n \nLaboratory services are quite varied as to how they identify the presence \nof Clostridium difficile. Some labs are set up to identify C. difficile as\nthe final microbiological (bacterial) etiology of a culture, even if a \nculture method was not used. Other labs use a final etiology of "see \ncomment" and then enter the results in a free text format. Still others \nenter the text under a hematology or chemistry format where a reference \nrange and "positive" and "negative" result values can be entered.  \nWherever the VHA Laboratory Service places the results, which are used to \nis associated with the presence of Clostridium difficile enterotoxin,\ndemonstrate the presence of toxin-producing C. difficile, should be \naccessible as a standardized field in order to allow the MDRO Programs \nTool software to capture its presence.  \n \nNOTE:  The purpose of adding Clostridium difficile to the MDRO Tools Lab \nParameter Setup is to identify a patient's current or prior history of \nClostridium difficile based on laboratory reporting and the time frames \nthat are entered to search for the patient's status.  The result must \noccur as a Clostridium difficile (a bacterial etiology) or as a \nretrievable "positive" result for a chemistry/serology laboratory test. \nwhich can cause significant morbidity, as well as mortality. It is of\nAny results contained in a "Free-Text" section will not allow \nincorporation of Clostridium difficile into the MDRO Program Tools \nsoftware CDI Report format.  Refer to the "VistA Lab Enhancements (VLE) - \nMicrobiology User Guide" for instructions to configure the MDRO Tools Lab \nParameter Setup to properly run the CDI Report.\nimportance, as its predominant acquisition appears to occur nosocomially\nand is the most serious cause of antibiotic-associated diarrhea. Presence\nof clostridial toxin (either enterotoxin or cytotoxin L) by assay (whether\nit be EIA, latex agglutination, cytotoxicity of cell culture\n+neutralization, or culture of organism with subsequent colony testing) is\nthe best indicator that an inflammatory diarrheal disease is due to\n
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Extended-spectrum beta-lactamase
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\nExtended-Spectrum Beta-Lactamases (ESBLs) are enzymes that mediate \nStandards Institute (CLSI) testing schema should be used. If an isolate is\nconfirmed as an ESBL-producer by the CLSI-recommended phenotypic \nconfirmatory test procedure, then all penicillins, cephalosporins and \naztreonams should be reported as resistant. Cephamycins should be reported\naccording to their routine test results.  \n \nNOTE: Adding Extended-Spectrum Beta Lactamase to the MDRO Tools Lab \nParameter Setup is optional. The purpose of adding pathogens containing \nthis form of antimicrobial resistance to the parameter set-up is to \nidentify a patient's current or prior history of ESBL based on laboratory \nresistance to extended-spectrum (third generation) cephalosporins (e.g., \nreporting and the time frames that are entered to search for the patient's\nstatus. This information can optionally be displayed on the Isolation\nReport. If you would like to incorporate ESBL into the Isolation report,\nthe result must occur as a retrievable result as a "bacterial etiology" or\nin the "BACT RPT REMARK" field. It is appropriate to used Canned Comments\nversus Free Text to retrieve results. If free-text is used, it is likely\nthe report will not display accurate information. Any results contained in\nthe "Comments" section will not allow incorporation of ESBL into the MDRO\nProgram Tools software Isolation Report format.\nceftazidime, cefotaxime, and ceftriaxone) and monobactams (e.g, aztreonam)\nbut do not affect cephamycins (e.g., cefoxitin and cefotetan) or\ncarbapenems (e.g., imipenem or meropenem).  \n \nESBLs can be difficult to detect because they have different levels of \nactivity against various cephalosporins. It is critical to test the \nappropriate antimicrobial agent. An appropriate Committee on Laboratory \n
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