Need for WHONET Documentation

April 1, 20120 comments

Antibiotics are considered as one of the strengths of modern Medicine, and have helped the humans to progress to the present stage, along with several other advances in Medicine. At present, the antibiotics are used for needy patients and are misused too when there is no need for an antibiotic prescription. Drug resistance develops naturally, but careless practices in drug supply and use are hastening it unnecessarily, we certainly need a system to document the results of antibiotic sensitivity and resistance patterns arising in our Institution, which can be documented with WHONET.

WHONET is free Windows-based database software developed for the management and analysis of microbiology laboratory data with a special focus on the analysis of antimicrobial susceptibility test results. These tools enable microbiology laboratory to put its test results into a database and conduct analysis to support local infection control and antibiotic usage at our hospital.

The software has been developed since 1989 by the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance based at the Brigham and Women's Hospital in Boston, and is used by clinical, public health, veterinary, and food laboratories in over 90 countries to support local and national surveillance programs. Laboratories can also upload files created by WHONET, to feed into national or other multi-centre surveillance networks and to strengthen our Drug policy. Such surveillance programs are now in place in many countries and part of accreditation standards in India.

How we can Progress with WHONET?

We can enhance the local data for local needs: clinical decision support, antimicrobial use policy, infection control and outbreak detection, identifying laboratory test performance, and characterization of local microbial and resistance epidemiology and to promote local, national, regional, and global collaborations through the exchange of data and sharing of experiences.

The WHONET experience suggests that pattern of drug resistance data can be collected and analysed in resource-constrained settings, using core microbiology, if local laboratories are given appropriate support. Strengthening these laboratories is therefore a potentially cost-effective contribution to both treating drug resistant disease and preventing its further spread. Microbiologists, clinicians and infection control workers may use this software to enhance monitoring of drug resistance in their hospitals and communities and to merge their files into national, regional, and global networks for surveillance of drug resistance. WHONET can also analyse stored data. From a single screen, a WHONET user selects the type of analysis to run, the species of bacteria to analyse, the subsets of isolates to include (e.g., all, isolates from urine, blood , and isolates resistant to Cephalosporin’s, Carbapenems or any other drug individually  and from certain locations  in outpatients and any wards  like ICCU’s  medicine, surgery or any other speciality).

Every patient in our hospital or its community carries a complex bacterial ecosystem and each patient care unit within the centre and ultimately the centre itself may be seen as an aggregated ecosystem. Resistance genes and the strains they make resistant move through these systems, selectively accelerated by specific antimicrobial agents given to specific patients and retarded by infection control practices. Both strategic and day-to-day management of those practices and the selection of those agents need optimal, current information about the linkages of the resistance genes and the deployment of the strains. The Microbiology laboratory at the hospitals also needs continuing analysis of its susceptibility test and quality control results. Each laboratory tests hundreds of different combinations of bacterial species and antimicrobial agents. Variations in the usual distributions of measurements for any of the combinations, and particularly of those that impinge upon breakpoints may signal either problems in test performance or new types of resistance.

Thus, WHONET helps our hospital:
  • Creates profile of the Bacterial Infections at our Hospital.
  • Helps to know the Antibiograms pattern of the different isolates.
  • Observe trends in MRSA, and  patterns of drug resistance in several GNB strains.
  • Alert the physicians on uncommon, clinically important bacterial pathogens.
  • Helps faculty to present data at academic associations and in publishing papers as per editorial guidelines.

However it needs greater cooperation of all clinicians to build the system to our hospital needs, and the protocols can be integrated into the antibiotic policy.

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Guest Post authored by:
*T.V.Rao, C.Aher, Deepa Babin, Deepthy Sooryadas
Department of Microbiology Travancore Medical College
Kollam, Kerala, India.
The author can be reached at 

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