WHONET DOCUMENTATION IN ANTIBIOTIC POLICY
Antibiotics are considered as strength of the Modern Medicine, and 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 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, It is crucial to monitor emerging trends in resistance at
the local level to support clinical decision making, infection-control interventions, and antimicrobial-
resistance containment strategies. Monitoring of antimicrobial resistance trends is commonly
performed in health care facilities using an annual summary of susceptibility rates, known as a
cumulative antibiogram report which can be documented with WHONET. However we are aware
that we have no documented protocols in India on making an antibiotic policy. At this hour WHONET
guides on many matters on happenings in our health care area on trends of Antibiotic sensitivity and
WHAT IS 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 laboratories to put its test
results into a database and conduct analysis to support local infection control and antibiotic usage at
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 our country.
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 its 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 areas
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 patient’s and retarded by
infection control practices. Both strategic and day-to-day management of those practices and of 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 our Hospital 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
Consensus guidelines have been developed by the CLSI to standardise methods used in constructing
antibiograms, with the goal of promoting the reporting of reliable and consistent antibiogram data.
The current guideline is CLSI M39-A3, entitled "Analysis and Presentation of Cumulative
Antimicrobial Susceptibility Test Data". The salient points of this document include the following.
•The data should be analysed annually. However, if there are a large number of isolates, this may be
done six monthly or more frequently.
•At least 30 isolates should be present for inclusion in the analysis.
•The isolates that are obtained from diagnostic testing should only be included and those from
surveillance cultures, e.g., MRSA screening should not be included. Colonisers should not be
•Include results for the antibiotics that are routinely tested.
•Only the first isolate from a patient irrespective of the specimen site should be included.
•The cumulative antibiogram should present only the percentage susceptible and not those which
are intermediate susceptible.
•It is useful to stratify the antibiogram into outpatient, inpatient and ICU
A present WHONET helps Hospitals Creates profile of the Bacterial Infections at our Hospital.
Helps to know the Antibiograms pattern of the different isolates. Trends in MRSA, and patterns of
drug resistance in several Gram negative bacterial strains.
We can alert the physicians on uncommon, clinically important bacterial pathogens.
Helps our faculty to present data at academic associations and in publishing papers as per editorial
However it needs greater cooperation of all Clinicians to build the system to our Hospital needs,
The protocols can be integrated into the Antibiotic policy and policy decisions can be
taken going through audited results from WHONET documentation
References 1 Hospital antibiogram: S Joshi necessity Department of Microbiology, Manipal Hospital,
98 Rustom Bagh, HAL Airport Road, Bangalore - 560 017, India
2 Clinical and Laboratory Standards Institute (CLSI). Analysis and presentation of cumulative
antimicrobial susceptibility test data. 3rd ed. Approved guideline M39-A3. Wayne PA. CLSI, 2009.
3Hindler JF, Stelling J. Analysis and presentation of cumulative antibiograms: A new consensus
guideline from the Clinical and Laboratory Standards Institute. Clin Infect Dis 2007; 44:867-73
Dr.T.V.Rao MD Professor of Microbiology Freelance writer