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# ==================================================================== #
# TITLE #
# Antimicrobial Resistance (AMR) Analysis #
# #
# AUTHORS #
# Berends MS (m.s.berends@umcg.nl), Luz CF (c.f.luz@umcg.nl) #
# #
# LICENCE #
# This program 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 program 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 for more details. #
# ==================================================================== #
#' Calculate resistance of isolates
#'
#' These functions can be used to calculate the (co-)resistance of microbial isolates (i.e. percentage S, SI, I, IR or R). All functions can be used in \code{dplyr}s \code{\link[dplyr]{summarise}} and support grouped variables, see \emph{Examples}.
#' @param ab,ab1,ab2 vector of antibiotic interpretations, they will be transformed internally with \code{\link{as.rsi}}
#' @param include_I logical to indicate whether antimicrobial interpretations of "I" should be included
#' @param minimum minimal amount of available isolates. Any number lower than \code{minimum} will return \code{NA}.
#' @param as_percent logical to indicate whether the output must be returned as percent (text), will else be a double
#' @param interpretation antimicrobial interpretation
#' @param info \emph{DEPRECATED} calculate the amount of available isolates and print it, like \code{n = 423}
#' @param warning \emph{DEPRECATED} show a warning when the available amount of isolates is below \code{minimum}
#' @details \strong{Remember that you should filter your table to let it contain only first isolates!} Use \code{\link{first_isolate}} to determine them in your data set.
#'
#' The functions \code{resistance}, \code{susceptibility} and \code{n_rsi} calculate using hybrid evaluation (i.e. using C++), which makes these functions 25-30 times faster than the old \code{rsi} function. This function is still available for backwards compatibility but is deprecated.
#' \if{html}{
#' \cr
#' To calculate the probability (\emph{p}) of susceptibility of one antibiotic, we use this formula:
#' \out{<div style="text-align: center">}\figure{mono_therapy.png}\out{</div>}
#' To calculate the probability (\emph{p}) of susceptibility of more antibiotics (i.e. combination therapy), we need to check whether one of them has a susceptible result (as numerator) and count all cases where all antibiotics were tested (as denominator). \cr
#' \cr
#' For two antibiotics:
#' \out{<div style="text-align: center">}\figure{combi_therapy_2.png}\out{</div>}
#' \cr
#' Theoretically for three antibiotics:
#' \out{<div style="text-align: center">}\figure{combi_therapy_3.png}\out{</div>}
#' }
#' @keywords resistance susceptibility rsi_df antibiotics isolate isolates
#' @return Double or, when \code{as_percent = TRUE}, a character.
#' @rdname resistance
#' @export
#' @examples
#' library(dplyr)
#'
#' septic_patients %>%
#' group_by(hospital_id) %>%
#' summarise(p = susceptibility(cipr),
#' n = n_rsi(cipr)) # n_rsi works like n_distinct in dplyr
#'
#' septic_patients %>%
#' group_by(hospital_id) %>%
#' summarise(cipro_p = susceptibility(cipr, as_percent = TRUE),
#' cipro_n = n_rsi(cipr),
#' genta_p = susceptibility(gent, as_percent = TRUE),
#' genta_n = n_rsi(gent),
#' combination_p = susceptibility(cipr, gent, as_percent = TRUE),
#' combination_n = n_rsi(cipr, gent))
#'
#'
#' # Calculate resistance
#' resistance(septic_patients$amox)
#' rsi(septic_patients$amox, interpretation = "IR") # deprecated
#'
#' # Or susceptibility
#' susceptibility(septic_patients$amox)
#' rsi(septic_patients$amox, interpretation = "S") # deprecated
#'
#'
#' # Calculate co-resistance between amoxicillin/clav acid and gentamicin,
#' # so we can see that combination therapy does a lot more than mono therapy:
#' susceptibility(septic_patients$amcl) # p = 67.8%
#' n_rsi(septic_patients$amcl) # n = 1641
#'
#' susceptibility(septic_patients$gent) # p = 69.1%
#' n_rsi(septic_patients$gent) # n = 1863
#'
#' with(septic_patients,
#' susceptibility(amcl, gent)) # p = 90.6%
#' with(septic_patients,
#' n_rsi(amcl, gent)) # n = 1580
#'
#' \dontrun{
#' # calculate current empiric combination therapy of Helicobacter gastritis:
#' my_table %>%
#' filter(first_isolate == TRUE,
#' genus == "Helicobacter") %>%
#' summarise(p = susceptibility(amox, metr), # amoxicillin with metronidazole
#' n = n_rsi(amox, metr))
#'
#'
#' # How fast is this hybrid evaluation in C++ compared to R?
#' # In other words: how is the speed improvement of the new `resistance` compared to old `rsi`?
#'
#' library(microbenchmark)
#' df <- septic_patients %>% group_by(hospital_id, bactid) # 317 groups with sizes 1 to 167
#'
#' microbenchmark(old_IR = df %>% summarise(p = rsi(amox, minimum = 0, interpretation = "IR")),
#' new_IR = df %>% summarise(p = resistance(amox, minimum = 0)),
#' old_S = df %>% summarise(p = rsi(amox, minimum = 0, interpretation = "S")),
#' new_S = df %>% summarise(p = susceptibility(amox, minimum = 0)),
#' times = 5,
#' unit = "s")
#'
#' # Unit: seconds
#' # expr min lq mean median uq max neval
#' # old_IR 1.95600230 1.96096857 1.97981537 1.96823318 2.00645711 2.00741568 5
#' # new_IR 0.06872808 0.06984932 0.07162866 0.06987306 0.07050094 0.07919192 5
#' # old_S 1.68893579 1.69024888 1.72461867 1.69785934 1.70428796 1.84176137 5
#' # new_S 0.06737037 0.06838167 0.07431906 0.07745364 0.07827224 0.08011738 5
#'
#' # The old function took roughly 2 seconds, the new ones take 0.07 seconds.
#' }
resistance <- function(ab,
include_I = TRUE,
minimum = 30,
as_percent = FALSE) {
if (NCOL(ab) > 1) {
stop('`ab` must be a vector of antimicrobial interpretations', call. = FALSE)
}
if (!is.logical(include_I)) {
stop('`include_I` must be logical', call. = FALSE)
}
if (!is.numeric(minimum)) {
stop('`minimum` must be numeric', call. = FALSE)
}
if (!is.logical(as_percent)) {
stop('`as_percent` must be logical', call. = FALSE)
}
if (!is.rsi(ab)) {
x <- as.rsi(ab)
warning("Increase speed by transforming to class `rsi` on beforehand: df %>% mutate_at(vars(col10:col20), as.rsi)")
} else {
x <- ab
}
total <- length(x) - sum(is.na(x)) # faster than C++
if (total < minimum) {
return(NA)
}
found <- .Call(`_AMR_rsi_calc_R`, x, include_I)
if (as_percent == TRUE) {
percent(found / total, force_zero = TRUE)
} else {
found / total
}
}
#' @rdname resistance
#' @export
susceptibility <- function(ab1,
ab2 = NULL,
include_I = FALSE,
minimum = 30,
as_percent = FALSE) {
if (NCOL(ab1) > 1) {
stop('`ab1` must be a vector of antimicrobial interpretations', call. = FALSE)
}
if (!is.logical(include_I)) {
stop('`include_I` must be logical', call. = FALSE)
}
if (!is.numeric(minimum)) {
stop('`minimum` must be numeric', call. = FALSE)
}
if (!is.logical(as_percent)) {
stop('`as_percent` must be logical', call. = FALSE)
}
print_warning <- FALSE
if (!is.rsi(ab1)) {
ab1 <- as.rsi(ab1)
print_warning <- TRUE
}
if (!is.null(ab2)) {
if (NCOL(ab2) > 1) {
stop('`ab2` must be a vector of antimicrobial interpretations', call. = FALSE)
}
if (!is.rsi(ab2)) {
ab2 <- as.rsi(ab2)
print_warning <- TRUE
}
x <- apply(X = data.frame(ab1 = as.integer(ab1),
ab2 = as.integer(ab2)),
MARGIN = 1,
FUN = min)
} else {
x <- ab1
}
total <- length(x) - sum(is.na(x))
if (total < minimum) {
return(NA)
}
found <- .Call(`_AMR_rsi_calc_S`, x, include_I)
if (print_warning == TRUE) {
warning("Increase speed by transforming to class `rsi` on beforehand: df %>% mutate_at(vars(col10:col20), as.rsi)")
}
if (as_percent == TRUE) {
percent(found / total, force_zero = TRUE)
} else {
found / total
}
}
#' @rdname resistance
#' @export
n_rsi <- function(ab1, ab2 = NULL) {
if (NCOL(ab1) > 1) {
stop('`ab1` must be a vector of antimicrobial interpretations', call. = FALSE)
}
if (!is.rsi(ab1)) {
ab1 <- as.rsi(ab1)
}
if (!is.null(ab2)) {
if (NCOL(ab2) > 1) {
stop('`ab2` must be a vector of antimicrobial interpretations', call. = FALSE)
}
if (!is.rsi(ab2)) {
ab2 <- as.rsi(ab2)
}
sum(!is.na(ab1) & !is.na(ab2))
} else {
sum(!is.na(ab1))
}
}
#' @rdname resistance
#' @export
rsi <- function(ab1,
ab2 = NA,
interpretation = 'IR',
minimum = 30,
as_percent = FALSE,
info = FALSE,
warning = TRUE) {
ab1.name <- deparse(substitute(ab1))
if (ab1.name %like% '.[$].') {
ab1.name <- unlist(strsplit(ab1.name, "$", fixed = TRUE))
ab1.name <- ab1.name[length(ab1.name)]
}
if (!ab1.name %like% '^[a-z]{3,4}$') {
ab1.name <- 'rsi1'
}
if (length(ab1) == 1 & is.character(ab1)) {
stop('`ab1` must be a vector of antibiotic interpretations.',
'\n Try rsi(', ab1, ', ...) instead of rsi("', ab1, '", ...)', call. = FALSE)
}
ab2.name <- deparse(substitute(ab2))
if (ab2.name %like% '.[$].') {
ab2.name <- unlist(strsplit(ab2.name, "$", fixed = TRUE))
ab2.name <- ab2.name[length(ab2.name)]
}
if (!ab2.name %like% '^[a-z]{3,4}$') {
ab2.name <- 'rsi2'
}
if (length(ab2) == 1 & is.character(ab2)) {
stop('`ab2` must be a vector of antibiotic interpretations.',
'\n Try rsi(', ab2, ', ...) instead of rsi("', ab2, '", ...)', call. = FALSE)
}
interpretation <- paste(interpretation, collapse = "")
ab1 <- as.rsi(ab1)
ab2 <- as.rsi(ab2)
tbl <- tibble(rsi1 = ab1, rsi2 = ab2)
colnames(tbl) <- c(ab1.name, ab2.name)
if (length(ab2) == 1) {
r <- rsi_df(tbl = tbl,
ab = ab1.name,
interpretation = interpretation,
minimum = minimum,
as_percent = FALSE,
info = info,
warning = warning)
} else {
if (length(ab1) != length(ab2)) {
stop('`ab1` (n = ', length(ab1), ') and `ab2` (n = ', length(ab2), ') must be of same length.', call. = FALSE)
}
if (!interpretation %in% c('S', 'IS', 'SI')) {
warning('`interpretation` not set to S or I/S, albeit analysing a combination therapy.', call. = FALSE)
}
r <- rsi_df(tbl = tbl,
ab = c(ab1.name, ab2.name),
interpretation = interpretation,
minimum = minimum,
as_percent = FALSE,
info = info,
warning = warning)
}
if (as_percent == TRUE) {
percent(r, force_zero = TRUE)
} else {
r
}
}
#' @importFrom dplyr %>% filter_at vars any_vars all_vars
#' @noRd
rsi_df <- function(tbl,
ab,
interpretation = 'IR',
minimum = 30,
as_percent = FALSE,
info = TRUE,
warning = TRUE) {
# in case tbl$interpretation already exists:
interpretations_to_check <- paste(interpretation, collapse = "")
# validate:
if (min(grepl('^[a-z]{3,4}$', ab)) == 0 &
min(grepl('^rsi[1-2]$', ab)) == 0) {
for (i in 1:length(ab)) {
ab[i] <- paste0('rsi', i)
}
}
if (!grepl('^(S|SI|IS|I|IR|RI|R){1}$', interpretations_to_check)) {
stop('Invalid `interpretation`; must be "S", "SI", "I", "IR", or "R".')
}
if ('is_ic' %in% colnames(tbl)) {
if (n_distinct(tbl$is_ic) > 1 & warning == TRUE) {
warning('Dataset contains isolates from the Intensive Care. Exclude them from proper epidemiological analysis.')
}
}
# transform when checking for different results
if (interpretations_to_check %in% c('SI', 'IS')) {
for (i in 1:length(ab)) {
tbl[which(tbl[, ab[i]] == 'I'), ab[i]] <- 'S'
}
interpretations_to_check <- 'S'
}
if (interpretations_to_check %in% c('RI', 'IR')) {
for (i in 1:length(ab)) {
tbl[which(tbl[, ab[i]] == 'I'), ab[i]] <- 'R'
}
interpretations_to_check <- 'R'
}
# get fraction
if (length(ab) == 1) {
numerator <- tbl %>%
filter(pull(., ab[1]) == interpretations_to_check) %>%
nrow()
denominator <- tbl %>%
filter(pull(., ab[1]) %in% c("S", "I", "R")) %>%
nrow()
} else if (length(ab) == 2) {
if (interpretations_to_check != 'S') {
warning('`interpretation` not set to S or I/S, albeit analysing a combination therapy.', call. = FALSE)
}
numerator <- tbl %>%
filter_at(vars(ab[1], ab[2]),
any_vars(. == interpretations_to_check)) %>%
filter_at(vars(ab[1], ab[2]),
all_vars(. %in% c("S", "R", "I"))) %>%
nrow()
denominator <- tbl %>%
filter_at(vars(ab[1], ab[2]),
all_vars(. %in% c("S", "R", "I"))) %>%
nrow()
} else {
stop('Maximum of 2 drugs allowed.')
}
# build text part
if (info == TRUE) {
cat('n =', denominator)
info.txt1 <- percent(denominator / nrow(tbl))
if (denominator == 0) {
info.txt1 <- 'none'
}
info.txt2 <- gsub(',', ' and',
ab %>%
abname(tolower = TRUE) %>%
toString(), fixed = TRUE)
info.txt2 <- gsub('rsi1 and rsi2', 'these two drugs', info.txt2, fixed = TRUE)
info.txt2 <- gsub('rsi1', 'this drug', info.txt2, fixed = TRUE)
cat(paste0(' (of ', nrow(tbl), ' in total; ', info.txt1, ' tested on ', info.txt2, ')\n'))
}
# calculate and format
y <- numerator / denominator
if (as_percent == TRUE) {
y <- percent(y, force_zero = TRUE)
}
if (denominator < minimum) {
if (warning == TRUE) {
warning(paste0('TOO FEW ISOLATES OF ', toString(ab), ' (n = ', denominator, ', n < ', minimum, '); NO RESULT.'))
}
y <- NA
}
# output
y
}
#' Predict antimicrobial resistance
#'
#' Create a prediction model to predict antimicrobial resistance for the next years on statistical solid ground. Standard errors (SE) will be returned as columns \code{se_min} and \code{se_max}. See Examples for a real live example.
#' @param tbl table that contains columns \code{col_ab} and \code{col_date}
#' @param col_ab column name of \code{tbl} with antimicrobial interpretations (\code{R}, \code{I} and \code{S}), supports tidyverse-like quotation
#' @param col_date column name of the date, will be used to calculate years if this column doesn't consist of years already, supports tidyverse-like quotation
#' @param year_max highest year to use in the prediction model, deafults to 15 years after today
#' @param year_every unit of sequence between lowest year found in the data and \code{year_max}
#' @param model the statistical model of choice. Valid values are \code{"binomial"} (or \code{"binom"} or \code{"logit"}) or \code{"loglin"} or \code{"linear"} (or \code{"lin"}).
#' @param I_as_R treat \code{I} as \code{R}
#' @param preserve_measurements overwrite predictions of years that are actually available in the data, with the original data. The standard errors of those years will be \code{NA}.
#' @param info print textual analysis with the name and \code{\link{summary}} of the model.
#' @return \code{data.frame} with columns \code{year}, \code{probR}, \code{se_min} and \code{se_max}.
#' @seealso \code{\link{resistance}} \cr \code{\link{lm}} \code{\link{glm}}
#' @rdname resistance_predict
#' @export
#' @importFrom dplyr %>% pull mutate group_by_at summarise filter
#' @importFrom reshape2 dcast
#' @examples
#' \dontrun{
#' # use it directly:
#' rsi_predict(tbl = tbl[which(first_isolate == TRUE & genus == "Haemophilus"),],
#' col_ab = "amcl", col_date = "date")
#'
#' # or with dplyr so you can actually read it:
#' library(dplyr)
#' tbl %>%
#' filter(first_isolate == TRUE,
#' genus == "Haemophilus") %>%
#' rsi_predict(amcl, date)
#' }
#'
#'
#' # real live example:
#' library(dplyr)
#' septic_patients %>%
#' # get bacteria properties like genus and species
#' left_join_microorganisms("bactid") %>%
#' # calculate first isolates
#' mutate(first_isolate =
#' first_isolate(.,
#' "date",
#' "patient_id",
#' "bactid",
#' col_specimen = NA,
#' col_icu = NA)) %>%
#' # filter on first E. coli isolates
#' filter(genus == "Escherichia",
#' species == "coli",
#' first_isolate == TRUE) %>%
#' # predict resistance of cefotaxime for next years
#' rsi_predict(col_ab = "cfot",
#' col_date = "date",
#' year_max = 2025,
#' preserve_measurements = FALSE)
#'
resistance_predict <- function(tbl,
col_ab,
col_date,
year_max = as.integer(format(as.Date(Sys.Date()), '%Y')) + 15,
year_every = 1,
model = 'binomial',
I_as_R = TRUE,
preserve_measurements = TRUE,
info = TRUE) {
if (nrow(tbl) == 0) {
stop('This table does not contain any observations.')
}
if (!col_ab %in% colnames(tbl)) {
stop('Column ', col_ab, ' not found.')
}
if (!col_date %in% colnames(tbl)) {
stop('Column ', col_date, ' not found.')
}
if ('grouped_df' %in% class(tbl)) {
# no grouped tibbles please, mutate will throw errors
tbl <- base::as.data.frame(tbl, stringsAsFactors = FALSE)
}
if (I_as_R == TRUE) {
tbl[, col_ab] <- gsub('I', 'R', tbl %>% pull(col_ab))
}
if (!all(tbl %>% pull(col_ab) %>% as.rsi() %in% c(NA, 'S', 'I', 'R'))) {
stop('Column ', col_ab, ' must contain antimicrobial interpretations (S, I, R).')
}
year <- function(x) {
if (all(grepl('^[0-9]{4}$', x))) {
x
} else {
as.integer(format(as.Date(x), '%Y'))
}
}
years_predict <- seq(from = min(year(tbl %>% pull(col_date))), to = year_max, by = year_every)
df <- tbl %>%
mutate(year = year(tbl %>% pull(col_date))) %>%
group_by_at(c('year', col_ab)) %>%
summarise(n())
colnames(df) <- c('year', 'antibiotic', 'count')
df <- df %>%
reshape2::dcast(year ~ antibiotic, value.var = 'count')
if (model %in% c('binomial', 'binom', 'logit')) {
logitmodel <- with(df, glm(cbind(R, S) ~ year, family = binomial))
if (info == TRUE) {
cat('\nLogistic regression model (logit) with binomial distribution')
cat('\n------------------------------------------------------------\n')
print(summary(logitmodel))
}
predictmodel <- stats::predict(logitmodel, newdata = with(df, list(year = years_predict)), type = "response", se.fit = TRUE)
prediction <- predictmodel$fit
se <- predictmodel$se.fit
} else if (model == 'loglin') {
loglinmodel <- with(df, glm(R ~ year, family = poisson))
if (info == TRUE) {
cat('\nLog-linear regression model (loglin) with poisson distribution')
cat('\n--------------------------------------------------------------\n')
print(summary(loglinmodel))
}
predictmodel <- stats::predict(loglinmodel, newdata = with(df, list(year = years_predict)), type = "response", se.fit = TRUE)
prediction <- predictmodel$fit
se <- predictmodel$se.fit
} else if (model %in% c('lin', 'linear')) {
linmodel <- with(df, lm((R / (R + S)) ~ year))
if (info == TRUE) {
cat('\nLinear regression model')
cat('\n-----------------------\n')
print(summary(linmodel))
}
predictmodel <- stats::predict(linmodel, newdata = with(df, list(year = years_predict)), se.fit = TRUE)
prediction <- predictmodel$fit
se <- predictmodel$se.fit
} else {
stop('No valid model selected.')
}
# prepare the output dataframe
prediction <- data.frame(year = years_predict, probR = prediction, stringsAsFactors = FALSE)
prediction$se_min <- prediction$probR - se
prediction$se_max <- prediction$probR + se
if (model == 'loglin') {
prediction$probR <- prediction$probR %>%
format(scientific = FALSE) %>%
as.integer()
prediction$se_min <- prediction$se_min %>% as.integer()
prediction$se_max <- prediction$se_max %>% as.integer()
colnames(prediction) <- c('year', 'amountR', 'se_max', 'se_min')
} else {
prediction$se_max[which(prediction$se_max > 1)] <- 1
}
prediction$se_min[which(prediction$se_min < 0)] <- 0
total <- prediction
if (preserve_measurements == TRUE) {
# geschatte data vervangen door gemeten data
if (I_as_R == TRUE) {
if (!'I' %in% colnames(df)) {
df$I <- 0
}
df$probR <- df$R / rowSums(df[, c('R', 'S', 'I')])
} else {
df$probR <- df$R / rowSums(df[, c('R', 'S')])
}
measurements <- data.frame(year = df$year,
probR = df$probR,
se_min = NA,
se_max = NA,
stringsAsFactors = FALSE)
colnames(measurements) <- colnames(prediction)
prediction <- prediction %>% filter(!year %in% df$year)
total <- rbind(measurements, prediction)
}
total
}
#' @rdname resistance_predict
#' @export
rsi_predict <- resistance_predict
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