The State of Hawai‘i Antimicrobial Resistance Project
The State of Hawai‘i Antimicrobial Resistance Project (SHARP) Data System is the repository for patient-specific antimicrobial susceptibility test (AST) result data from four major commercial and individual hospital laboratories statewide: Kaiser Permanente Research Laboratory; Tripler Army Medical Center; Diagnostic Laboratory Services, Inc.; and Clinical Laboratories of Hawai‘i, LLC. AST data are generated through a bacterial analyzer (VITEK II and occasionally MicroScan) and, wherever possible, through a link to the laboratory information system (LIS). The laboratory data providers all follow the Clinical Laboratory Standards Institute (CLSI) guidelines for susceptibility interpretation. The data, submitted biannually, include the variables of organism, antimicrobial agent, AST method, result, susceptibility interpretation, specimen collection date, service provider code, patient location, and specimen source. With limitations, demographic patient information such as name, birth date, and gender are also submitted to SHARP.
The database is the focal point of the SHARP Data System. Its value as a relational database is enhanced by the data warehouse attached to it and the user interface designed to facilitate data warehouse access without the need for technical background on the part of the user. The data warehouse increases the efficiency of the data system by storing selected values and algorithms for the more frequently required procedures, saving time and resources by avoiding repeated calculations. It also allows a wider user audience access to basic cross-tabulations that can be generated in a matter of minutes.
The SHARP database collects data on over 300 microorganisms sampled from inpatients (ICU and non-ICU), outpatients, nursing care facility residents, and correctional institution patients. Since the data are received in different formats, standard values are set by the Hawai‘i Department of Health (HDOH) for each variable, based primarily on laboratory-specific coding conventions and Clinical Laboratory Standards Institute (CLSI) guidelines.
Although SHARP data consist of AST result data and demographics, the system does not distinguish between unique individuals. SHARP does not collect standard federal or state identifiers such as social security numbers or driver’s license numbers. This fits the surveillance purpose of the database which was never designed to track individual patients or to be a real-time resource.
Although SHARP is not a patient-based system, the information allows distinctions to be made between records of different people. This makes possible the de-duplication of data that include repeated tests for a given patient to monitor the susceptibility status of the organism in question to a specific drug administered, until either the patient is discharged or the AST result changes to “resistant.” SHARP data are de-duplicated on PID, patient name, organism, drug, and susceptibility group. The SHARP data warehouse contains algorithms to allow analysis of de-duplicated data based on a choice of time intervals (i.e., 10 days, 30 days, 90 days, or 365 days), where the default for SHARP is 90 days. As of October 2010, there were 10,391,000 records in SHARP. Upon 90-day de-duplication, the number decreases to slightly more than 9,000,000. The source of the de-duplication methodology developed in SHARP is the publication by Li F, Ayers TL, Park SY, Miller FD, MacFadden R, Nakata M, et al. Isolate removal methods and methicillin-resistant Staphylococcus aureus surveillance.
Emerging Infectious Diseases. 2005 October.
State of Hawaii Antibiogram 2008
State of Hawaii Antibiogram 2009 – coming soon!
For more information, visit the following Department of Health pages:
Group A Streptococcus
For information about antimicrobial resistance surveillance, research, and education programs, please visit the selected sites listed below.
Centers for Disease Control and Prevention (CDC)
Clinical Laboratory Standard Institute (CLSI)