# ==================================================================== # # TITLE # # Antimicrobial Resistance (AMR) Analysis # # # # AUTHORS # # Berends MS (m.s.berends@umcg.nl), Luz CF (c.f.luz@umcg.nl) # # # # LICENCE # # This package is free software; you can redistribute it and/or modify # # it under the terms of the GNU General Public License version 2.0, # # as published by the Free Software Foundation. # # # # This R package is distributed in the hope that it will be useful, # # but WITHOUT ANY WARRANTY; without even the implied warranty of # # MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the # # GNU General Public License version 2.0 for more details. # # ==================================================================== # #' Determine multidrug-resistant organisms (MDRO) #' #' Determine which isolates are multidrug-resistant organisms (MDRO) according to country-specific guidelines. #' @param tbl table with antibiotic columns, like e.g. \code{amox} and \code{amcl} #' @param country country code to determine guidelines. EUCAST rules will be used when left empty, see Details. Should be or a code from the \href{https://en.wikipedia.org/wiki/ISO_3166-1_alpha-2#Officially_assigned_code_elements}{list of ISO 3166-1 alpha-2 country codes}. Case-insensitive. Currently supported are \code{de} (Germany) and \code{nl} (the Netherlands). #' @param info print progress #' @inheritParams eucast_rules #' @param metr column name of an antibiotic, see Antibiotics #' @param ... parameters that are passed on to methods #' @inheritSection eucast_rules Antibiotics #' @details When \code{country} will be left blank, guidelines will be taken from EUCAST Expert Rules Version 3.1 "Intrinsic Resistance and Exceptional Phenotypes Tables" (\url{http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Expert_Rules/Expert_rules_intrinsic_exceptional_V3.1.pdf}). #' @return Ordered factor with levels \code{Negative < Positive, unconfirmed < Positive}. #' @rdname mdro #' @importFrom dplyr %>% #' @importFrom crayon red blue #' @export #' @examples #' library(dplyr) #' #' septic_patients %>% #' mutate(EUCAST = mdro(.), #' BRMO = brmo(.)) mdro <- function(tbl, country = NULL, col_mo = NULL, info = TRUE, amcl = 'amcl', amik = 'amik', amox = 'amox', ampi = 'ampi', azit = 'azit', aztr = 'aztr', cefa = 'cefa', cfra = 'cfra', cfep = 'cfep', cfot = 'cfot', cfox = 'cfox', cfta = 'cfta', cftr = 'cftr', cfur = 'cfur', chlo = 'chlo', cipr = 'cipr', clar = 'clar', clin = 'clin', clox = 'clox', coli = 'coli', czol = 'czol', dapt = 'dapt', doxy = 'doxy', erta = 'erta', eryt = 'eryt', fosf = 'fosf', fusi = 'fusi', gent = 'gent', imip = 'imip', kana = 'kana', levo = 'levo', linc = 'linc', line = 'line', mero = 'mero', metr = 'metr', mino = 'mino', moxi = 'moxi', nali = 'nali', neom = 'neom', neti = 'neti', nitr = 'nitr', novo = 'novo', norf = 'norf', oflo = 'oflo', peni = 'peni', pipe = 'pipe', pita = 'pita', poly = 'poly', qida = 'qida', rifa = 'rifa', roxi = 'roxi', siso = 'siso', teic = 'teic', tetr = 'tetr', tica = 'tica', tige = 'tige', tobr = 'tobr', trim = 'trim', trsu = 'trsu', vanc = 'vanc', col_bactid = NULL) { if (!is.data.frame(tbl)) { stop("`tbl` must be a data frame.", call. = FALSE) } # try to find columns based on type # -- mo if (!is.null(col_bactid)) { col_mo <- col_bactid warning("Use of `col_bactid` is deprecated. Use `col_mo` instead.") } else if (is.null(col_mo) & "mo" %in% lapply(tbl, class)) { col_mo <- colnames(tbl)[lapply(tbl, class) == "mo"][1] message("NOTE: Using column `", col_mo, "` as input for `col_mo`.") } else if (!col_mo %in% colnames(tbl)) { stop('Column ', col_mo, ' not found.', call. = FALSE) } # strip whitespaces if (length(country) > 1) { stop('`country` must be a length one character string.', call. = FALSE) } if (is.null(country)) { country <- 'EUCAST' } country <- trimws(country) if (tolower(country) != 'eucast' & !country %like% '^[a-z]{2}$') { stop('This is not a valid ISO 3166-1 alpha-2 country code: "', country, '". Please see ?mdro.', call. = FALSE) } # create list and make country code case-independent guideline <- list(country = list(code = tolower(country))) if (guideline$country$code == 'eucast') { guideline$country$name <- '(European guidelines)' guideline$name <- 'EUCAST Expert Rules, "Intrinsic Resistance and Exceptional Phenotypes Tables"' guideline$version <- 'Version 3.1' guideline$source <- 'http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Expert_Rules/Expert_rules_intrinsic_exceptional_V3.1.pdf' # support per country: } else if (guideline$country$code == 'de') { guideline$country$name <- 'Germany' guideline$name <- '' guideline$version <- '' guideline$source <- '' } else if (guideline$country$code == 'nl') { guideline$country$name <- 'The Netherlands' guideline$name <- 'WIP-Richtlijn BRMO' guideline$version <- 'Revision of December 2017' guideline$source <- 'https://www.rivm.nl/Documenten_en_publicaties/Professioneel_Praktisch/Richtlijnen/Infectieziekten/WIP_Richtlijnen/WIP_Richtlijnen/Ziekenhuizen/WIP_richtlijn_BRMO_Bijzonder_Resistente_Micro_Organismen_ZKH' # add here more countries like this: # } else if (country$code == 'xx') { # country$name <- 'country name' } else { stop('This country code is currently unsupported: ', guideline$country$code, call. = FALSE) } if (info == TRUE) { cat("Determining multidrug-resistant organisms (MDRO), according to:\n", "Guideline: ", red(paste0(guideline$name, ", ", guideline$version, "\n")), "Country : ", red(paste0(guideline$country$name, "\n")), "Source : ", blue(paste0(guideline$source, "\n")), "\n", sep = "") } # check columns col.list <- c(amcl, amik, amox, ampi, azit, aztr, cefa, cfra, cfep, cfot, cfox, cfta, cftr, cfur, chlo, cipr, clar, clin, clox, coli, czol, dapt, doxy, erta, eryt, fosf, fusi, gent, imip, kana, levo, linc, line, mero, metr, mino, moxi, nali, neom, neti, nitr, novo, norf, oflo, peni, pita, poly, qida, rifa, roxi, siso, teic, tetr, tica, tige, tobr, trim, trsu, vanc) col.list <- check_available_columns(tbl = tbl, col.list = col.list, info = info) amcl <- col.list[amcl] amik <- col.list[amik] amox <- col.list[amox] ampi <- col.list[ampi] azit <- col.list[azit] aztr <- col.list[aztr] cefa <- col.list[cefa] cfra <- col.list[cfra] cfep <- col.list[cfep] cfot <- col.list[cfot] cfox <- col.list[cfox] cfta <- col.list[cfta] cftr <- col.list[cftr] cfur <- col.list[cfur] chlo <- col.list[chlo] cipr <- col.list[cipr] clar <- col.list[clar] clin <- col.list[clin] clox <- col.list[clox] coli <- col.list[coli] czol <- col.list[czol] dapt <- col.list[dapt] doxy <- col.list[doxy] erta <- col.list[erta] eryt <- col.list[eryt] fosf <- col.list[fosf] fusi <- col.list[fusi] gent <- col.list[gent] imip <- col.list[imip] kana <- col.list[kana] levo <- col.list[levo] linc <- col.list[linc] line <- col.list[line] mero <- col.list[mero] metr <- col.list[metr] mino <- col.list[mino] moxi <- col.list[moxi] nali <- col.list[nali] neom <- col.list[neom] neti <- col.list[neti] nitr <- col.list[nitr] novo <- col.list[novo] norf <- col.list[norf] oflo <- col.list[oflo] peni <- col.list[peni] pita <- col.list[pita] poly <- col.list[poly] qida <- col.list[qida] rifa <- col.list[rifa] roxi <- col.list[roxi] siso <- col.list[siso] teic <- col.list[teic] tetr <- col.list[tetr] tica <- col.list[tica] tige <- col.list[tige] tobr <- col.list[tobr] trim <- col.list[trim] trsu <- col.list[trsu] vanc <- col.list[vanc] # antibiotic classes aminoglycosides <- c(tobr, gent) # can also be kana but that one is often intrinsic R cephalosporins <- c(cfep, cfot, cfox, cfra, cfta, cftr, cfur, czol) cephalosporins_3rd <- c(cfot, cftr, cfta) carbapenems <- c(erta, imip, mero) fluoroquinolones <- c(oflo, cipr, levo, moxi) # helper function for editing the table trans_tbl <- function(to, rows, cols, any_all) { cols <- cols[!is.na(cols)] if (length(rows) > 0 & length(cols) > 0) { if (any_all == "any") { col_filter <- which(tbl[, cols] == 'R') } else if (any_all == "all") { col_filter <- tbl %>% mutate(index = 1:nrow(.)) %>% filter_at(vars(cols), all_vars(. == "R")) %>% pull((index)) } rows <- rows[rows %in% col_filter] tbl[rows, 'MDRO'] <<- to } } if (!tbl %>% pull(col_mo) %>% is.mo()) { tbl[, col_mo] <- as.mo(tbl[, col_mo]) } tbl <- tbl %>% # join to microorganisms data set left_join_microorganisms(by = col_mo) %>% # add unconfirmed to where genus is available mutate(MDRO = ifelse(!is.na(genus), 1, NA_integer_)) if (guideline$country$code == 'eucast') { # EUCAST ------------------------------------------------------------------ # Table 5 trans_tbl(3, which(tbl$family == 'Enterobacteriaceae' | tbl$fullname %like% '^Pseudomonas aeruginosa' | tbl$genus == 'Acinetobacter'), coli, "all") trans_tbl(3, which(tbl$fullname %like% '^Salmonella Typhi'), c(carbapenems, fluoroquinolones), "any") trans_tbl(3, which(tbl$fullname %like% '^Haemophilus influenzae'), c(cephalosporins_3rd, carbapenems, fluoroquinolones), "any") trans_tbl(3, which(tbl$fullname %like% '^Moraxella catarrhalis'), c(cephalosporins_3rd, fluoroquinolones), "any") trans_tbl(3, which(tbl$fullname %like% '^Neisseria meningitidis'), c(cephalosporins_3rd, fluoroquinolones), "any") trans_tbl(3, which(tbl$fullname %like% '^Neisseria gonorrhoeae'), azit, "any") # Table 6 trans_tbl(3, which(tbl$fullname %like% '^Staphylococcus (aureus|epidermidis|coagulase negatief|hominis|haemolyticus|intermedius|pseudointermedius)'), c(vanc, teic, dapt, line, qida, tige), "any") trans_tbl(3, which(tbl$genus == 'Corynebacterium'), c(vanc, teic, dapt, line, qida, tige), "any") trans_tbl(3, which(tbl$fullname %like% '^Streptococcus pneumoniae'), c(carbapenems, vanc, teic, dapt, line, qida, tige, rifa), "any") trans_tbl(3, # Sr. groups A/B/C/G which(tbl$fullname %like% '^Streptococcus (pyogenes|agalactiae|equisimilis|equi|zooepidemicus|dysgalactiae|anginosus)'), c(peni, cephalosporins, vanc, teic, dapt, line, qida, tige), "any") trans_tbl(3, which(tbl$genus == 'Enterococcus'), c(dapt, line, tige, teic), "any") trans_tbl(3, which(tbl$fullname %like% '^Enterococcus faecalis'), c(ampi, amox), "any") # Table 7 trans_tbl(3, which(tbl$genus == 'Bacteroides'), metr, "any") trans_tbl(3, which(tbl$fullname %like% '^Clostridium difficile'), c(metr, vanc), "any") } if (guideline$country$code == 'de') { # Germany ----------------------------------------------------------------- stop("We are still working on German guidelines in this beta version.", call. = FALSE) } if (guideline$country$code == 'nl') { # Netherlands ------------------------------------------------------------- aminoglycosides <- aminoglycosides[!is.na(aminoglycosides)] fluoroquinolones <- fluoroquinolones[!is.na(fluoroquinolones)] carbapenems <- carbapenems[!is.na(carbapenems)] # Table 1 trans_tbl(3, which(tbl$family == 'Enterobacteriaceae'), c(aminoglycosides, fluoroquinolones), "all") trans_tbl(2, which(tbl$family == 'Enterobacteriaceae'), c(carbapenems), "any") # Table 2 trans_tbl(2, which(tbl$genus == 'Acinetobacter'), c(carbapenems), "any") trans_tbl(3, which(tbl$genus == 'Acinetobacter'), c(aminoglycosides, fluoroquinolones), "all") trans_tbl(3, which(tbl$fullname %like% '^Stenotrophomonas maltophilia'), trsu, "all") if (!is.na(mero) & !is.na(imip) & !is.na(gent) & !is.na(tobr) & !is.na(cipr) & !is.na(cfta) & !is.na(pita) ) { tbl <- tbl %>% mutate( psae = 0, psae = ifelse(mero == "R" | imip == "R", psae + 1, psae), psae = ifelse(gent == "R" & tobr == "R", psae + 1, psae), psae = ifelse(cipr == "R", psae + 1, psae), psae = ifelse(cfta == "R", psae + 1, psae), psae = ifelse(pita == "R", psae + 1, psae), psae = ifelse(is.na(psae), 0, psae) ) } else { tbl$psae <- 0 } tbl[which( tbl$fullname %like% 'Pseudomonas aeruginosa' & tbl$psae >= 3 ), 'MDRO'] <- 3 # Table 3 trans_tbl(3, which(tbl$fullname %like% 'Streptococcus pneumoniae'), peni, "all") trans_tbl(3, which(tbl$fullname %like% 'Streptococcus pneumoniae'), vanc, "all") trans_tbl(3, which(tbl$fullname %like% 'Enterococcus faecium'), c(peni, vanc), "all") } factor(x = tbl$MDRO, levels = 1:3, labels = c('Negative', 'Positive, unconfirmed', 'Positive'), ordered = TRUE) } #' @rdname mdro #' @export brmo <- function(..., country = "nl") { mdro(..., country = "nl") } #' @rdname mdro #' @export mrgn <- function(tbl, country = "de", ...) { mdro(tbl = tbl, country = "de", ...) } #' @rdname mdro #' @export eucast_exceptional_phenotypes <- function(tbl, country = "EUCAST", ...) { mdro(tbl = tbl, country = "EUCAST", ...) }