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322 lines
14 KiB
Markdown
Executable File
322 lines
14 KiB
Markdown
Executable File
# `AMR`
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### An [R package](https://www.r-project.org) to simplify the analysis and prediction of Antimicrobial Resistance (AMR) and work with antibiotic properties by using evidence-based methods.
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This R package was created for academic research by PhD students of the Faculty of Medical Sciences of the [University of Groningen](https://www.rug.nl) and the Medical Microbiology & Infection Prevention (MMBI) department of the [University Medical Center Groningen (UMCG)](https://www.umcg.nl).
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:arrow_forward: Download it with `install.packages("AMR")` or see below for other possibilities.
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## Authors
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- [Berends MS](https://github.com/msberends)<sup>1,2</sup>, PhD Student
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- [Luz CF](https://github.com/ceefluz)<sup>1</sup>, PhD Student
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- [Hassing EEA](https://github.com/erwinhassing)<sup>2</sup>, Data Analyst (contributor)
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<sup>1</sup> Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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<sup>2</sup> Certe Medical Diagnostics & Advice, Groningen, the Netherlands
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<a href="https://www.rug.nl"><img src="man/figures/logo_rug.png" height="60px"></a>
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<a href="https://www.umcg.nl"><img src="man/figures/logo_umcg.png" height="60px"></a>
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<a href="https://www.certe.nl"><img src="man/figures/logo_certe.png" height="60px"></a>
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<a href="http://www.eurhealth-1health.eu"><img src="man/figures/logo_eh1h.png" height="60px"></a>
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<a href="http://www.eurhealth-1health.eu"><img src="man/figures/logo_interreg.png" height="60px"></a>
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## Why this package?
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This R package contains functions to make **microbiological, epidemiological data analysis easier**. It allows the use of some new classes to work with MIC values and antimicrobial interpretations (i.e. values S, I and R).
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With `AMR` you can also:
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* Conduct AMR analysis with the `rsi` function, that can also be used with the `dplyr` package (e.g. in conjunction with `summarise`) to calculate the resistance percentages (and even co-resistance) of different antibiotic columns of a table
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* Predict antimicrobial resistance for the nextcoming years with the `rsi_predict` function
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* Apply [EUCAST rules to isolates](http://www.eucast.org/expert_rules_and_intrinsic_resistance/) with the `EUCAST_rules` function
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* Identify first isolates of every patient [using guidelines from the CLSI](https://clsi.org/standards/products/microbiology/documents/m39/) (Clinical and Laboratory Standards Institute) with the `first_isolate` function
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* Get antimicrobial ATC properties from the WHO Collaborating Centre for Drug Statistics Methodology ([WHOCC](https://www.whocc.no/atc_ddd_methodology/who_collaborating_centre/)), to be able to:
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* Translate antibiotic codes (like *AMOX*), official names (like *amoxicillin*) and even trade names (like *Amoxil* or *Trimox*) to an [ATC code](https://www.whocc.no/atc_ddd_index/?code=J01CA04&showdescription=no) (like *J01CA04*) and vice versa with the `abname` function
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* Get the latest antibiotic properties like hierarchic groups and [defined daily dose](https://en.wikipedia.org/wiki/Defined_daily_dose) (DDD) with units and administration form from the WHOCC website with the `atc_property` function
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* Create frequency tables with the `freq` function
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With the `MDRO` function (abbreviation of Multi Drug Resistant Organisms), you can check your isolates for exceptional resistance with country-specific guidelines or EUCAST rules. Currently guidelines for Germany and the Netherlands are supported. Please suggest addition of your own country here: [https://github.com/msberends/AMR/issues/new](https://github.com/msberends/AMR/issues/new?title=New%20guideline%20for%20MDRO&body=%3C--%20Please%20add%20your%20country%20code,%20guideline%20name,%20version%20and%20source%20below%20and%20remove%20this%20line--%3E).
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This package contains an example data set `septic_patients`, consisting of 2000 isolates from anonymised septic patients between 2001 and 2017.
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## How to get it?
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This package is available on CRAN and also here on GitHub.
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### From CRAN (recommended)
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[](http://cran.r-project.org/package=AMR)
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[](http://cran.r-project.org/package=AMR)
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[](http://cran.r-project.org/package=AMR)
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- <img src="http://www.rstudio.com/favicon.ico" alt="RStudio favicon" height="20px"> In [RStudio](http://www.rstudio.com) (recommended):
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- Click on `Tools` and then `Install Packages...`
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- Type in `AMR` and press <kbd>Install</kbd>
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- <img src="https://cran.r-project.org/favicon.ico" alt="R favicon" height="20px"> In R directly:
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- `install.packages("AMR")`
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- <img src="https://exploratory.io/favicon.ico" alt="Exploratory favicon" height="20px"> In [Exploratory.io](https://exploratory.io):
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- (Exploratory.io costs $40/month but the somewhat limited Community Plan is free for students and teachers, [click here to enroll](https://exploratory.io/plan?plan=Community))
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- Start the software and log in
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- Click on your username at the right hand side top
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- Click on `R Packages`
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- Click on the `Install` tab
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- Type in `AMR` and press <kbd>Install</kbd>
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- Once it’s installed it will show up in the `User Packages` section under the `Packages` tab.
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### From GitHub (latest development version)
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[](https://travis-ci.org/msberends/AMR)
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[](https://github.com/msberends/AMR/commits/master)
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[](https://github.com/msberends/AMR/commits/master)
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[](https://codecov.io/gh/msberends/AMR)
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```r
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install.packages("devtools")
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devtools::install_github("msberends/AMR")
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```
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## How to use it?
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```r
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# Call it with:
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library(AMR)
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# For a list of functions:
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help(package = "AMR")
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```
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### Overwrite/force resistance based on EUCAST rules
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This is also called *interpretive reading*.
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```r
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before <- data.frame(bactid = c("STAAUR", # Staphylococcus aureus
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"ENCFAE", # Enterococcus faecalis
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"ESCCOL", # Escherichia coli
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"KLEPNE", # Klebsiella pneumoniae
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"PSEAER"), # Pseudomonas aeruginosa
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vanc = "-", # Vancomycin
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amox = "-", # Amoxicillin
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coli = "-", # Colistin
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cfta = "-", # Ceftazidime
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cfur = "-", # Cefuroxime
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stringsAsFactors = FALSE)
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before
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# bactid vanc amox coli cfta cfur
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# 1 STAAUR - - - - -
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# 2 ENCFAE - - - - -
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# 3 ESCCOL - - - - -
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# 4 KLEPNE - - - - -
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# 5 PSEAER - - - - -
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# Now apply those rules; just need a column with bacteria ID's and antibiotic results:
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after <- EUCAST_rules(before)
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after
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# bactid vanc amox coli cfta cfur
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# 1 STAAUR - - R R -
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# 2 ENCFAE - - R R R
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# 3 ESCCOL R - - - -
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# 4 KLEPNE R R - - -
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# 5 PSEAER R R - - R
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```
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### Frequency tables
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Base R lacks a simple function to create frequency tables. We created such a function that works with almost all data types: `freq` (or `frequency_tbl`).
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```r
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## Factors sort on item by default:
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freq(septic_patients$hospital_id)
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# Class: factor
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# Length: 2000 (of which NA: 0 = 0.0%)
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# Unique: 5
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#
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# Item Count Percent Cum. Count Cum. Percent (Factor Level)
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# ----- ------ -------- ----------- ------------- ---------------
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# A 233 11.7% 233 11.7% 1
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# B 583 29.1% 816 40.8% 2
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# C 221 11.1% 1037 51.8% 3
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# D 650 32.5% 1687 84.4% 4
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# E 313 15.7% 2000 100.0% 5
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## This can be changed with the `sort.count` parameter:
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freq(septic_patients$hospital_id, sort.count = TRUE)
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# Class: factor
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# Length: 2000 (of which NA: 0 = 0.0%)
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# Unique: 5
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#
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# Item Count Percent Cum. Count Cum. Percent (Factor Level)
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# ----- ------ -------- ----------- ------------- ---------------
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# D 650 32.5% 650 32.5% 4
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# B 583 29.1% 1233 61.7% 2
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# E 313 15.7% 1546 77.3% 5
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# A 233 11.7% 1779 88.9% 1
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# C 221 11.1% 2000 100.0% 3
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## Other types, like numbers or dates, sort on count by default:
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> freq(septic_patients$date)
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# Class: Date
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# Length: 2000 (of which NA: 0 = 0.0%)
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# Unique: 1662
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#
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# Oldest: 2 January 2001
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# Newest: 18 October 2017 (+6133)
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#
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# Item Count Percent Cum. Count Cum. Percent
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# ----------- ------ -------- ----------- -------------
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# 2008-12-24 5 0.2% 5 0.2%
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# 2010-12-10 4 0.2% 9 0.4%
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# 2011-03-03 4 0.2% 13 0.6%
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# 2013-06-24 4 0.2% 17 0.8%
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# 2017-09-01 4 0.2% 21 1.1%
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# 2002-09-02 3 0.2% 24 1.2%
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# 2003-10-14 3 0.2% 27 1.4%
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# 2004-06-25 3 0.2% 30 1.5%
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# 2004-06-27 3 0.2% 33 1.7%
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# 2004-10-29 3 0.2% 36 1.8%
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# 2005-09-27 3 0.2% 39 2.0%
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# 2006-08-01 3 0.2% 42 2.1%
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# 2006-10-10 3 0.2% 45 2.2%
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# 2007-11-16 3 0.2% 48 2.4%
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# 2008-03-09 3 0.2% 51 2.5%
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# ... and 1647 more (n = 1949; 97.5%). Use `nmax` to show more rows.
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## For numeric values, some extra descriptive statistics will be calculated:
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> freq(runif(n = 10, min = 1, max = 5))
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# Class: numeric
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# Length: 10 (of which NA: 0 = 0.0%)
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# Unique: 10
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#
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# Mean: 3
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# Std. dev.: 0.93 (CV: 0.31)
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# Five-Num: 1.1 | 2.3 | 3.1 | 3.8 | 4.0 (CQV: 0.25)
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# Outliers: 0
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#
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# Item Count Percent Cum. Count Cum. Percent
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# --------- ------ -------- ----------- -------------
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# 1.132033 1 10.0% 1 10.0%
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# 2.226903 1 10.0% 2 20.0%
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# 2.280779 1 10.0% 3 30.0%
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# 2.640898 1 10.0% 4 40.0%
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# 2.913462 1 10.0% 5 50.0%
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# 3.364201 1 10.0% 6 60.0%
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# 3.771975 1 10.0% 7 70.0%
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# 3.802861 1 10.0% 8 80.0%
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# 3.803547 1 10.0% 9 90.0%
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# 3.985691 1 10.0% 10 100.0%
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#
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# Warning message:
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# All observations are unique.
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```
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Learn more about this function with:
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```r
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?freq
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```
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### New classes
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This package contains two new S3 classes: `mic` for MIC values (e.g. from Vitek or Phoenix) and `rsi` for antimicrobial drug interpretations (i.e. S, I and R). Both are actually ordered factors under the hood (an MIC of `2` being higher than `<=1` but lower than `>=32`, and for class `rsi` factors are ordered as `S < I < R`).
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Both classes have extensions for existing generic functions like `print`, `summary` and `plot`.
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```r
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# Transform values to new classes
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mic_data <- as.mic(c(">=32", "1.0", "8", "<=0.128", "8", "16", "16"))
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rsi_data <- as.rsi(c(rep("S", 474), rep("I", 36), rep("R", 370)))
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```
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These functions also try to coerce valid values.
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Quick overviews when just printing objects:
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```r
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mic_data
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# Class 'mic': 7 isolates
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#
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# <NA> 0
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#
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# <=0.128 1 8 16 >=32
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# 1 1 2 2 1
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rsi_data
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# Class 'rsi': 880 isolates
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#
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# <NA>: 0
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# Sum of S: 474
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# Sum of IR: 406
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# - Sum of R: 370
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# - Sum of I: 36
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#
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# %S %IR %I %R
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# 53.9 46.1 4.1 42.0
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```
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A plot of `rsi_data`:
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```r
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plot(rsi_data)
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```
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A plot of `mic_data` (defaults to bar plot):
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```r
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plot(mic_data)
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```
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Other epidemiological functions:
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```r
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# Determine key antibiotic based on bacteria ID
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key_antibiotics(...)
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# Selection of first isolates of any patient
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first_isolate(...)
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# Calculate resistance levels of antibiotics, can be used with `summarise` (dplyr)
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rsi(...)
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# Predict resistance levels of antibiotics
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rsi_predict(...)
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# Get name of antibiotic by ATC code
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abname(...)
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abname("J01CR02", from = "atc", to = "umcg") # "AMCL"
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```
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### Databases included in package
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Datasets to work with antibiotics and bacteria properties.
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```r
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# Dataset with 2000 random blood culture isolates from anonymised
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# septic patients between 2001 and 2017 in 5 Dutch hospitals
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septic_patients # A tibble: 4,000 x 47
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# Dataset with ATC antibiotics codes, official names, trade names
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# and DDD's (oral and parenteral)
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antibiotics # A tibble: 420 x 18
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# Dataset with bacteria codes and properties like gram stain and
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# aerobic/anaerobic
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microorganisms # A tibble: 2,453 x 12
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```
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## Copyright
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[](https://github.com/msberends/AMR/blob/master/LICENSE)
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This R package is licensed under the [GNU General Public License (GPL) v2.0](https://github.com/msberends/AMR/blob/master/LICENSE). In a nutshell, this means that this package:
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- May be used for commercial purposes
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- May be used for private purposes
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- May **not** be used for patent purposes
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- May be modified, although:
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- Modifications **must** be released under the same license when distributing the package
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- Changes made to the code **must** be documented
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- May be distributed, although:
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- Source code **must** be made available when the package is distributed
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- A copy of the license and copyright notice **must** be included with the package.
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- Comes with a LIMITATION of liability
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- Comes with NO warranty
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