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< h1 > How to determine multi-drug resistance (MDR)< / h1 >
< h4 class = "author" > Matthijs S. Berends< / h4 >
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< h4 class = "date" > 03 June 2019< / h4 >
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< div class = "hidden name" > < code > MDR.Rmd< / code > < / div >
< / div >
< p > With the function < code > < a href = "../reference/mdro.html" > mdro()< / a > < / code > , you can determine multi-drug resistant organisms (MDRO). It currently support these guidelines:< / p >
< ul >
< li > “Intrinsic Resistance and Exceptional Phenotypes Tables”, by EUCAST (European Committee on Antimicrobial Susceptibility Testing)< / li >
< li > “Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis”, by WHO (World Health Organization)< / li >
< li > “WIP-Richtlijn Bijzonder Resistente Micro-organismen (BRMO)”, by RIVM (Rijksinstituut voor de Volksgezondheid, the Netherlands National Institute for Public Health and the Environment)< / li >
< / ul >
< p > As an example, I will make a data set to determine multi-drug resistant TB:< / p >
< div class = "sourceCode" id = "cb1" > < pre class = "sourceCode r" > < code class = "sourceCode r" > < a class = "sourceLine" id = "cb1-1" title = "1" > < span class = "co" > # a helper function to get a random vector with values S, I and R< / span > < / a >
< a class = "sourceLine" id = "cb1-2" title = "2" > < span class = "co" > # with the probabilities 50%-10%-40%< / span > < / a >
< a class = "sourceLine" id = "cb1-3" title = "3" > sample_rsi < -< span class = "st" > < / span > < span class = "cf" > function< / span > () {< / a >
< a class = "sourceLine" id = "cb1-4" title = "4" > < span class = "kw" > < a href = "https://www.rdocumentation.org/packages/base/topics/sample" > sample< / a > < / span > (< span class = "kw" > < a href = "https://www.rdocumentation.org/packages/base/topics/c" > c< / a > < / span > (< span class = "st" > "S"< / span > , < span class = "st" > "I"< / span > , < span class = "st" > "R"< / span > ),< / a >
< a class = "sourceLine" id = "cb1-5" title = "5" > < span class = "dt" > size =< / span > < span class = "dv" > 5000< / span > ,< / a >
< a class = "sourceLine" id = "cb1-6" title = "6" > < span class = "dt" > prob =< / span > < span class = "kw" > < a href = "https://www.rdocumentation.org/packages/base/topics/c" > c< / a > < / span > (< span class = "fl" > 0.5< / span > , < span class = "fl" > 0.1< / span > , < span class = "fl" > 0.4< / span > ),< / a >
< a class = "sourceLine" id = "cb1-7" title = "7" > < span class = "dt" > replace =< / span > < span class = "ot" > TRUE< / span > )< / a >
< a class = "sourceLine" id = "cb1-8" title = "8" > }< / a >
< a class = "sourceLine" id = "cb1-9" title = "9" > < / a >
< a class = "sourceLine" id = "cb1-10" title = "10" > my_TB_data < -< span class = "st" > < / span > < span class = "kw" > < a href = "https://www.rdocumentation.org/packages/base/topics/data.frame" > data.frame< / a > < / span > (< span class = "dt" > rifampicin =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb1-11" title = "11" > < span class = "dt" > isoniazid =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb1-12" title = "12" > < span class = "dt" > gatifloxacin =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb1-13" title = "13" > < span class = "dt" > ethambutol =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb1-14" title = "14" > < span class = "dt" > pyrazinamide =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb1-15" title = "15" > < span class = "dt" > moxifloxacin =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb1-16" title = "16" > < span class = "dt" > kanamycin =< / span > < span class = "kw" > sample_rsi< / span > ())< / a > < / code > < / pre > < / div >
< p > Because all column names are automatically verified for valid drug names or codes, this would have worked exactly the same:< / p >
< div class = "sourceCode" id = "cb2" > < pre class = "sourceCode r" > < code class = "sourceCode r" > < a class = "sourceLine" id = "cb2-1" title = "1" > my_TB_data < -< span class = "st" > < / span > < span class = "kw" > < a href = "https://www.rdocumentation.org/packages/base/topics/data.frame" > data.frame< / a > < / span > (< span class = "dt" > RIF =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb2-2" title = "2" > < span class = "dt" > INH =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb2-3" title = "3" > < span class = "dt" > GAT =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb2-4" title = "4" > < span class = "dt" > ETH =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb2-5" title = "5" > < span class = "dt" > PZA =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb2-6" title = "6" > < span class = "dt" > MFX =< / span > < span class = "kw" > sample_rsi< / span > (),< / a >
< a class = "sourceLine" id = "cb2-7" title = "7" > < span class = "dt" > KAN =< / span > < span class = "kw" > sample_rsi< / span > ())< / a > < / code > < / pre > < / div >
< p > The data set looks like this now:< / p >
< div class = "sourceCode" id = "cb3" > < pre class = "sourceCode r" > < code class = "sourceCode r" > < a class = "sourceLine" id = "cb3-1" title = "1" > < span class = "kw" > < a href = "https://www.rdocumentation.org/packages/utils/topics/head" > head< / a > < / span > (my_TB_data)< / a >
< a class = "sourceLine" id = "cb3-2" title = "2" > < span class = "co" > # rifampicin isoniazid gatifloxacin ethambutol pyrazinamide moxifloxacin< / span > < / a >
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< a class = "sourceLine" id = "cb3-3" title = "3" > < span class = "co" > # 1 S S S R I S< / span > < / a >
< a class = "sourceLine" id = "cb3-4" title = "4" > < span class = "co" > # 2 R R R I R S< / span > < / a >
< a class = "sourceLine" id = "cb3-5" title = "5" > < span class = "co" > # 3 R S S S S I< / span > < / a >
< a class = "sourceLine" id = "cb3-6" title = "6" > < span class = "co" > # 4 S R S R S S< / span > < / a >
< a class = "sourceLine" id = "cb3-7" title = "7" > < span class = "co" > # 5 R S S S S R< / span > < / a >
< a class = "sourceLine" id = "cb3-8" title = "8" > < span class = "co" > # 6 R S S S R R< / span > < / a >
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< a class = "sourceLine" id = "cb3-9" title = "9" > < span class = "co" > # kanamycin< / span > < / a >
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< a class = "sourceLine" id = "cb3-10" title = "10" > < span class = "co" > # 1 R< / span > < / a >
< a class = "sourceLine" id = "cb3-11" title = "11" > < span class = "co" > # 2 R< / span > < / a >
< a class = "sourceLine" id = "cb3-12" title = "12" > < span class = "co" > # 3 S< / span > < / a >
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< a class = "sourceLine" id = "cb3-13" title = "13" > < span class = "co" > # 4 S< / span > < / a >
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< a class = "sourceLine" id = "cb3-14" title = "14" > < span class = "co" > # 5 R< / span > < / a >
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< a class = "sourceLine" id = "cb3-15" title = "15" > < span class = "co" > # 6 S< / span > < / a > < / code > < / pre > < / div >
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< p > We can now add the interpretation of MDR-TB to our data set:< / p >
< div class = "sourceCode" id = "cb4" > < pre class = "sourceCode r" > < code class = "sourceCode r" > < a class = "sourceLine" id = "cb4-1" title = "1" > my_TB_data< span class = "op" > $< / span > mdr < -< span class = "st" > < / span > < span class = "kw" > < a href = "../reference/mdro.html" > mdr_tb< / a > < / span > (my_TB_data)< / a >
< a class = "sourceLine" id = "cb4-2" title = "2" > < span class = "co" > # < / span > < span class = "al" > NOTE< / span > < span class = "co" > : No column found as input for `col_mo`, assuming all records contain Mycobacterium tuberculosis.< / span > < / a >
< a class = "sourceLine" id = "cb4-3" title = "3" > < span class = "co" > # Determining multidrug-resistant organisms (MDRO), according to:< / span > < / a >
< a class = "sourceLine" id = "cb4-4" title = "4" > < span class = "co" > # Guideline: Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis< / span > < / a >
< a class = "sourceLine" id = "cb4-5" title = "5" > < span class = "co" > # Version: WHO/HTM/TB/2014.11< / span > < / a >
< a class = "sourceLine" id = "cb4-6" title = "6" > < span class = "co" > # Author: WHO (World Health Organization)< / span > < / a >
< a class = "sourceLine" id = "cb4-7" title = "7" > < span class = "co" > # Source: https://www.who.int/tb/publications/pmdt_companionhandbook/en/< / span > < / a >
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< a class = "sourceLine" id = "cb4-8" title = "8" > < span class = "co" > # Warning: Reliability might be improved if these antimicrobial results would< / span > < / a >
< a class = "sourceLine" id = "cb4-9" title = "9" > < span class = "co" > # be available too: CAP (capreomycin), RIB (rifabutin), RFP (rifapentine)< / span > < / a > < / code > < / pre > < / div >
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< p > And review the result with a frequency table:< / p >
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< div class = "sourceCode" id = "cb5" > < pre class = "sourceCode r" > < code class = "sourceCode r" > < a class = "sourceLine" id = "cb5-1" title = "1" > < span class = "kw" > < a href = "../reference/freq.html" > freq< / a > < / span > (my_TB_data< span class = "op" > $< / span > mdr)< / a > < / code > < / pre > < / div >
< p > < strong > Frequency table of < code > mdr< / code > from < code > my_TB_data< / code > (5,000 x 8)< / strong > < / p >
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< p > Class: factor > ordered (numeric)< br >
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Length: 5,000 (of which NA: 0 = 0.00%)< br >
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Levels: 5: Negative < Mono-resistance < Poly-resistance < Multidrug resistance…< br >
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Unique: 5< / p >
< table class = "table" >
< thead > < tr class = "header" >
< th align = "left" > < / th >
< th align = "left" > Item< / th >
< th align = "right" > Count< / th >
< th align = "right" > Percent< / th >
< th align = "right" > Cum. Count< / th >
< th align = "right" > Cum. Percent< / th >
< / tr > < / thead >
< tbody >
< tr class = "odd" >
< td align = "left" > 1< / td >
< td align = "left" > Mono-resistance< / td >
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< td align = "right" > 3,238< / td >
< td align = "right" > 64.8%< / td >
< td align = "right" > 3,238< / td >
< td align = "right" > 64.8%< / td >
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< / tr >
< tr class = "even" >
< td align = "left" > 2< / td >
< td align = "left" > Negative< / td >
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< td align = "right" > 662< / td >
< td align = "right" > 13.2%< / td >
< td align = "right" > 3,900< / td >
< td align = "right" > 78.0%< / td >
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< / tr >
< tr class = "odd" >
< td align = "left" > 3< / td >
< td align = "left" > Multidrug resistance< / td >
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< td align = "right" > 613< / td >
< td align = "right" > 12.3%< / td >
< td align = "right" > 4,513< / td >
< td align = "right" > 90.3%< / td >
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< / tr >
< tr class = "even" >
< td align = "left" > 4< / td >
< td align = "left" > Poly-resistance< / td >
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< td align = "right" > 279< / td >
< td align = "right" > 5.6%< / td >
< td align = "right" > 4,792< / td >
< td align = "right" > 95.8%< / td >
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< / tr >
< tr class = "odd" >
< td align = "left" > 5< / td >
< td align = "left" > Extensive drug resistance< / td >
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< td align = "right" > 208< / td >
< td align = "right" > 4.2%< / td >
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< td align = "right" > 5,000< / td >
< td align = "right" > 100.0%< / td >
< / tr >
< / tbody >
< / table >
< / div >
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< p > Developed by < a href = "https://www.rug.nl/staff/m.s.berends/" > Matthijs S. Berends< / a > , < a href = "https://www.rug.nl/staff/c.f.luz/" > Christian F. Luz< / a > , < a href = "https://www.rug.nl/staff/c.glasner/" > Corinna Glasner< / a > , < a href = "https://www.rug.nl/staff/a.w.friedrich/" > Alex W. Friedrich< / a > , < a href = "https://www.rug.nl/staff/b.sinha/" > Bhanu N. M. Sinha< / a > .< / p >
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