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# ==================================================================== #
# TITLE #
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# AMR: An R Package for Working with Antimicrobial Resistance Data #
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# #
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# SOURCE #
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# https://github.com/msberends/AMR #
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# #
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# CITE AS #
# Berends MS, Luz CF, Friedrich AW, Sinha BNM, Albers CJ, Glasner C #
# (2022). AMR: An R Package for Working with Antimicrobial Resistance #
# Data. Journal of Statistical Software, 104(3), 1-31. #
# doi:10.18637/jss.v104.i03 #
# #
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# Developed at the University of Groningen and the University Medical #
# Center Groningen in The Netherlands, in collaboration with many #
# colleagues from around the world, see our website. #
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# #
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# This R package is free software; you can freely use and distribute #
# it for both personal and commercial purposes under the terms of the #
# GNU General Public License version 2.0 (GNU GPL-2), as published by #
# the Free Software Foundation. #
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# We created this package for both routine data analysis and academic #
# research and it was publicly released in the hope that it will be #
# useful, but it comes WITHOUT ANY WARRANTY OR LIABILITY. #
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# #
# Visit our website for the full manual and a complete tutorial about #
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# how to conduct AMR data analysis: https://msberends.github.io/AMR/ #
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# ==================================================================== #
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#' Calculate Antimicrobial Resistance
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#'
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#' @description These functions can be used to calculate the (co-)resistance or susceptibility of microbial isolates (i.e. percentage of S, SI, I, IR or R). All functions support quasiquotation with pipes, can be used in `summarise()` from the `dplyr` package and also support grouped variables, see *Examples*.
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#'
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#' [resistance()] should be used to calculate resistance, [susceptibility()] should be used to calculate susceptibility.\cr
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#' @param ... one or more vectors (or columns) with antibiotic interpretations. They will be transformed internally with [as.sir()] if needed. Use multiple columns to calculate (the lack of) co-resistance: the probability where one of two drugs have a resistant or susceptible result. See *Examples*.
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#' @param minimum the minimum allowed number of available (tested) isolates. Any isolate count lower than `minimum` will return `NA` with a warning. The default number of `30` isolates is advised by the Clinical and Laboratory Standards Institute (CLSI) as best practice, see *Source*.
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#' @param as_percent a [logical] to indicate whether the output must be returned as a hundred fold with % sign (a character). A value of `0.123456` will then be returned as `"12.3%"`.
#' @param only_all_tested (for combination therapies, i.e. using more than one variable for `...`): a [logical] to indicate that isolates must be tested for all antibiotics, see section *Combination Therapy* below
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#' @param data a [data.frame] containing columns with class [`sir`] (see [as.sir()])
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#' @param translate_ab a column name of the [antibiotics] data set to translate the antibiotic abbreviations to, using [ab_property()]
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#' @inheritParams ab_property
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#' @param combine_SI a [logical] to indicate whether all values of S and I must be merged into one, so the output only consists of S+I vs. R (susceptible vs. resistant) - the default is `TRUE`
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#' @param ab_result antibiotic results to test against, must be one or more values of "S", "I", or "R"
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#' @param confidence_level the confidence level for the returned confidence interval. For the calculation, the number of S or SI isolates, and R isolates are compared with the total number of available isolates with R, S, or I by using [binom.test()], i.e., the Clopper-Pearson method.
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#' @param side the side of the confidence interval to return. The default is `"both"` for a length 2 vector, but can also be (abbreviated as) `"min"`/`"left"`/`"lower"`/`"less"` or `"max"`/`"right"`/`"higher"`/`"greater"`.
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#' @param collapse a [logical] to indicate whether the output values should be 'collapsed', i.e. be merged together into one value, or a character value to use for collapsing
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#' @inheritSection as.sir Interpretation of SIR
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#' @details
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#' The function [resistance()] is equal to the function [proportion_R()]. The function [susceptibility()] is equal to the function [proportion_SI()].
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#'
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#' Use [sir_confidence_interval()] to calculate the confidence interval, which relies on [binom.test()], i.e., the Clopper-Pearson method. This function returns a vector of length 2 at default for antimicrobial *resistance*. Change the `side` argument to "left"/"min" or "right"/"max" to return a single value, and change the `ab_result` argument to e.g. `c("S", "I")` to test for antimicrobial *susceptibility*, see Examples.
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#'
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#' **Remember that you should filter your data to let it contain only first isolates!** This is needed to exclude duplicates and to reduce selection bias. Use [first_isolate()] to determine them in your data set with one of the four available algorithms.
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#'
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#' These functions are not meant to count isolates, but to calculate the proportion of resistance/susceptibility. Use the [`count()`][AMR::count()] functions to count isolates. The function [susceptibility()] is essentially equal to `count_susceptible() / count_all()`. *Low counts can influence the outcome - the `proportion` functions may camouflage this, since they only return the proportion (albeit being dependent on the `minimum` argument).*
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#'
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#' The function [proportion_df()] takes any variable from `data` that has an [`sir`] class (created with [as.sir()]) and calculates the proportions S, I, and R. It also supports grouped variables. The function [sir_df()] works exactly like [proportion_df()], but adds the number of isolates.
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#' @section Combination Therapy:
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#' When using more than one variable for `...` (= combination therapy), use `only_all_tested` to only count isolates that are tested for all antibiotics/variables that you test them for. See this example for two antibiotics, Drug A and Drug B, about how [susceptibility()] works to calculate the %SI:
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#'
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#'
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#' ```
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#' --------------------------------------------------------------------
#' only_all_tested = FALSE only_all_tested = TRUE
#' ----------------------- -----------------------
#' Drug A Drug B include as include as include as include as
#' numerator denominator numerator denominator
#' -------- -------- ---------- ----------- ---------- -----------
#' S or I S or I X X X X
#' R S or I X X X X
#' <NA> S or I X X - -
#' S or I R X X X X
#' R R - X - X
#' <NA> R - - - -
#' S or I <NA> X X - -
#' R <NA> - - - -
#' <NA> <NA> - - - -
#' --------------------------------------------------------------------
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#' ```
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#'
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#' Please note that, in combination therapies, for `only_all_tested = TRUE` applies that:
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#'
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#' ```
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#' count_S() + count_I() + count_R() = count_all()
#' proportion_S() + proportion_I() + proportion_R() = 1
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#' ```
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#'
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#' and that, in combination therapies, for `only_all_tested = FALSE` applies that:
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#'
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#' ```
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#' count_S() + count_I() + count_R() >= count_all()
#' proportion_S() + proportion_I() + proportion_R() >= 1
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#' ```
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#'
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#' Using `only_all_tested` has no impact when only using one antibiotic as input.
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#' @source **M39 Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data, 5th Edition**, 2022, *Clinical and Laboratory Standards Institute (CLSI)*. <https://clsi.org/standards/products/microbiology/documents/m39/>.
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#' @seealso [AMR::count()] to count resistant and susceptible isolates.
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#' @return A [double] or, when `as_percent = TRUE`, a [character].
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#' @rdname proportion
#' @aliases portion
#' @name proportion
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#' @export
#' @examples
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#' # example_isolates is a data set available in the AMR package.
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#' # run ?example_isolates for more info.
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#' example_isolates
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#'
#'
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#' # base R ------------------------------------------------------------
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#' # determines %R
#' resistance(example_isolates$AMX)
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#' sir_confidence_interval(example_isolates$AMX)
#' sir_confidence_interval(example_isolates$AMX,
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#' confidence_level = 0.975
#' )
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#' sir_confidence_interval(example_isolates$AMX,
#' confidence_level = 0.975,
#' collapse = ", "
#' )
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#'
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#' # determines %S+I:
#' susceptibility(example_isolates$AMX)
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#' sir_confidence_interval(example_isolates$AMX,
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#' ab_result = c("S", "I")
#' )
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#'
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#' # be more specific
#' proportion_S(example_isolates$AMX)
#' proportion_SI(example_isolates$AMX)
#' proportion_I(example_isolates$AMX)
#' proportion_IR(example_isolates$AMX)
#' proportion_R(example_isolates$AMX)
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#'
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#' # dplyr -------------------------------------------------------------
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#' \donttest{
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#' if (require("dplyr")) {
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#' example_isolates %>%
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#' group_by(ward) %>%
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#' summarise(
#' r = resistance(CIP),
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#' n = n_sir(CIP)
#' ) # n_sir works like n_distinct in dplyr, see ?n_sir
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#' }
#' if (require("dplyr")) {
#' example_isolates %>%
#' group_by(ward) %>%
#' summarise(
#' cipro_R = resistance(CIP),
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#' ci_min = sir_confidence_interval(CIP, side = "min"),
#' ci_max = sir_confidence_interval(CIP, side = "max"),
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#' )
#' }
#' if (require("dplyr")) {
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#' # scoped dplyr verbs with antibiotic selectors
#' # (you could also use across() of course)
#' example_isolates %>%
#' group_by(ward) %>%
#' summarise_at(
#' c(aminoglycosides(), carbapenems()),
#' resistance
#' )
#' }
#' if (require("dplyr")) {
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#' example_isolates %>%
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#' group_by(ward) %>%
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#' summarise(
#' R = resistance(CIP, as_percent = TRUE),
#' SI = susceptibility(CIP, as_percent = TRUE),
#' n1 = count_all(CIP), # the actual total; sum of all three
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#' n2 = n_sir(CIP), # same - analogous to n_distinct
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#' total = n()
#' ) # NOT the number of tested isolates!
#'
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#' # Calculate co-resistance between amoxicillin/clav acid and gentamicin,
#' # so we can see that combination therapy does a lot more than mono therapy:
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#' example_isolates %>% susceptibility(AMC) # %SI = 76.3%
#' example_isolates %>% count_all(AMC) # n = 1879
#'
#' example_isolates %>% susceptibility(GEN) # %SI = 75.4%
#' example_isolates %>% count_all(GEN) # n = 1855
#'
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#' example_isolates %>% susceptibility(AMC, GEN) # %SI = 94.1%
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#' example_isolates %>% count_all(AMC, GEN) # n = 1939
#'
#'
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#' # See Details on how `only_all_tested` works. Example:
#' example_isolates %>%
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#' summarise(
#' numerator = count_susceptible(AMC, GEN),
#' denominator = count_all(AMC, GEN),
#' proportion = susceptibility(AMC, GEN)
#' )
#'
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#' example_isolates %>%
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#' summarise(
#' numerator = count_susceptible(AMC, GEN, only_all_tested = TRUE),
#' denominator = count_all(AMC, GEN, only_all_tested = TRUE),
#' proportion = susceptibility(AMC, GEN, only_all_tested = TRUE)
#' )
#'
#'
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#' example_isolates %>%
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#' group_by(ward) %>%
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#' summarise(
#' cipro_p = susceptibility(CIP, as_percent = TRUE),
#' cipro_n = count_all(CIP),
#' genta_p = susceptibility(GEN, as_percent = TRUE),
#' genta_n = count_all(GEN),
#' combination_p = susceptibility(CIP, GEN, as_percent = TRUE),
#' combination_n = count_all(CIP, GEN)
#' )
#'
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#' # Get proportions S/I/R immediately of all sir columns
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#' example_isolates %>%
#' select(AMX, CIP) %>%
#' proportion_df(translate = FALSE)
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#'
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#' # It also supports grouping variables
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#' # (use sir_df to also include the count)
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#' example_isolates %>%
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#' select(ward, AMX, CIP) %>%
#' group_by(ward) %>%
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#' sir_df(translate = FALSE)
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#' }
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#' }
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resistance <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = " R" ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}
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#' @rdname proportion
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#' @export
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susceptibility <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = c ( " S" , " I" ) ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
}
#' @rdname proportion
#' @export
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sir_confidence_interval <- function ( ... ,
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ab_result = " R" ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ,
confidence_level = 0.95 ,
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side = " both" ,
collapse = FALSE ) {
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meet_criteria ( ab_result , allow_class = c ( " character" , " sir" ) , has_length = c ( 1 , 2 , 3 ) , is_in = c ( " S" , " I" , " R" ) )
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meet_criteria ( minimum , allow_class = c ( " numeric" , " integer" ) , has_length = 1 , is_positive_or_zero = TRUE , is_finite = TRUE )
meet_criteria ( as_percent , allow_class = " logical" , has_length = 1 )
meet_criteria ( only_all_tested , allow_class = " logical" , has_length = 1 )
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meet_criteria ( confidence_level , allow_class = " numeric" , is_positive = TRUE , has_length = 1 )
meet_criteria ( side , allow_class = " character" , has_length = 1 , is_in = c ( " both" , " b" , " left" , " l" , " lower" , " lowest" , " less" , " min" , " right" , " r" , " higher" , " highest" , " greater" , " g" , " max" ) )
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meet_criteria ( collapse , allow_class = c ( " logical" , " character" ) , has_length = 1 )
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x <- tryCatch (
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sir_calc ( ... ,
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ab_result = ab_result ,
only_all_tested = only_all_tested ,
only_count = TRUE
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) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
n <- tryCatch (
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sir_calc ( ... ,
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ab_result = c ( " S" , " I" , " R" ) ,
only_all_tested = only_all_tested ,
only_count = TRUE
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) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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# this applies the Clopper-Pearson method
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out <- stats :: binom.test ( x = x , n = n , conf.level = confidence_level ) $ conf.int
out <- set_clean_class ( out , " double" )
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if ( side %in% c ( " left" , " l" , " lower" , " lowest" , " less" , " min" ) ) {
out <- out [1 ]
} else if ( side %in% c ( " right" , " r" , " higher" , " highest" , " greater" , " g" , " max" ) ) {
out <- out [2 ]
}
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if ( isTRUE ( as_percent ) ) {
out <- percentage ( out , digits = 1 )
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} else {
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out <- round ( out , digits = 3 )
}
if ( ! isFALSE ( collapse ) && length ( out ) > 1 ) {
out <- paste ( out , collapse = ifelse ( isTRUE ( collapse ) , " -" , collapse ) )
}
if ( n < minimum ) {
warning_ ( " Introducing NA: " ,
ifelse ( n == 0 , " no" , paste ( " only" , n ) ) ,
" results available for `sir_confidence_interval()` (`minimum` = " , minimum , " )." ,
call = FALSE
)
if ( is.character ( out ) ) {
return ( NA_character_ )
} else {
return ( NA_real_ )
}
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}
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out
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}
#' @rdname proportion
#' @export
proportion_R <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = " R" ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}
#' @rdname proportion
#' @export
proportion_IR <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = c ( " I" , " R" ) ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}
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#' @rdname proportion
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#' @export
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proportion_I <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = " I" ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}
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#' @rdname proportion
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#' @export
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proportion_SI <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = c ( " S" , " I" ) ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}
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#' @rdname proportion
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#' @export
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proportion_S <- function ( ... ,
minimum = 30 ,
as_percent = FALSE ,
only_all_tested = FALSE ) {
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tryCatch (
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sir_calc ( ... ,
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ab_result = " S" ,
minimum = minimum ,
as_percent = as_percent ,
only_all_tested = only_all_tested ,
only_count = FALSE
) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}
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#' @rdname proportion
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#' @export
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proportion_df <- function ( data ,
translate_ab = " name" ,
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language = get_AMR_locale ( ) ,
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minimum = 30 ,
as_percent = FALSE ,
combine_SI = TRUE ,
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confidence_level = 0.95 ) {
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tryCatch (
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sir_calc_df (
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type = " proportion" ,
data = data ,
translate_ab = translate_ab ,
language = language ,
minimum = minimum ,
as_percent = as_percent ,
combine_SI = combine_SI ,
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confidence_level = confidence_level
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) ,
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error = function ( e ) stop_ ( gsub ( " in sir_calc_df(): " , " " , e $ message , fixed = TRUE ) , call = -5 )
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)
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}