Digital Infrastructure for Antimicrobial Susceptibility Testing and Surveillance: A CLSI and EUCAST-Based Model for Resource-Limited Settings (Preprint) Article Swipe

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Mbarushimana Djibril , Gatera Jean Damascene , Muritala Issa Bale , Buregeya Jean Damascene , Kayitesi Marie Francoise , Itangishaka Innocent , Rugamba Alexis , Adeyemo Rasheed Omotayo , Bagirinshuti Issa , Adeniran Sanmi Adekunle , A. A. Adedeji , Mushuru Evariste , Busumbigabo Albert , Mukamana Felicite , Habarurema Sylvain , Felix Habarugira , Jean Paul Sinumvayo , Rutambika Noel , Twagirumugabe Theogene , Ndoli Minega Jules , Ngarambe Christian , Adegboyega Taofeek Tope ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.2196/preprints.82727

BACKGROUND Antimicrobial resistance (AMR) poses a significant global health threat, requiring effective antimicrobial susceptibility testing (AST) and surveillance systems. At the University Teaching Hospital of Butare (CHUB) in Rwanda, a baseline Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) identified critical gaps in the Laboratory Information System (LIS), including low capture rates for culture observation (60%) and AST data (25%), no standardization of AST panels (0%), and limited cumulative antibiogram generation (17%). OBJECTIVE This study aimed to develop an enhanced LIS to improve AST reliability and enable real-time Antimicrobial Resistance (AMR) surveillance at CHUB, addressing challenges in resource-limited settings to support antimicrobial stewardship and improve patient care. METHODS We developed an enhanced LIS using the OpenClinic GA open-source hospital information system, integrating Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines, and leveraging metadata from the AMR for R package and EUCAST Expert Rules. An agile development approach was employed, incorporating a custom database schema, Java-based application programming interfaces (APIs), and web-based user interfaces. The system was designed to support Minimum Inhibitory Concentration (MIC) and Disk Diffusion (DD) methods, automate result interpretation with color-coded outputs, prioritize WHO AWaRe “Access” antibiotics, and enable data export to WHONet for global surveillance. RESULTS The enhanced LIS improved AST data capture and standardization, providing reliable, automated result interpretation and real-time AMR surveillance capabilities. The system’s user-friendly interface and compatibility with WHONet facilitated seamless data integration and reporting, addressing previous deficiencies in data capture and antibiogram generation. CONCLUSIONS This scalable, open-source LIS model enhances antimicrobial stewardship by improving AST reliability and surveillance in resource-limited settings. By addressing critical gaps at CHUB, the system supports better patient outcomes and contributes to global AMR monitoring efforts.

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Type: article
Language: en
Landing Page: https://doi.org/10.2196/preprints.82727
PDF: https://s3.ca-central-1.amazonaws.com/assets.jmir.org/assets/preprints/preprint-82727-submitted.pdf
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DOI: https://doi.org/10.2196/preprints.82727

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Title: Digital Infrastructure for Antimicrobial Susceptibility Testing and Surveillance: A CLSI and EUCAST-Based Model for Resource-Limited Settings (Preprint)

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Publication year: 2025

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Authors: Mbarushimana Djibril, Gatera Jean Damascene, Muritala Issa Bale, Buregeya Jean Damascene, Kayitesi Marie Francoise, Itangishaka Innocent, Rugamba Alexis, Adeyemo Rasheed Omotayo, Bagirinshuti Issa, Adeniran Sanmi Adekunle, A. A. Adedeji, Mushuru Evariste, Busumbigabo Albert, Mukamana Felicite, Habarurema Sylvain, Felix Habarugira, Jean Paul Sinumvayo, Rutambika Noel, Twagirumugabe Theogene, Ndoli Minega Jules, Ngarambe Christian, Adegboyega Taofeek Tope

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Landing page: https://doi.org/10.2196/preprints.82727

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abstract_inverted_index.Assessment	33
abstract_inverted_index.Inhibitory	182
abstract_inverted_index.Java-based	166
abstract_inverted_index.Laboratory	32, 45, 129
abstract_inverted_index.OpenClinic	120
abstract_inverted_index.Resistance	36, 92
abstract_inverted_index.University	22
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abstract_inverted_index.challenges	98
abstract_inverted_index.cumulative	69
abstract_inverted_index.generation	71
abstract_inverted_index.identified	40
abstract_inverted_index.interfaces	169
abstract_inverted_index.leveraging	143
abstract_inverted_index.monitoring	292
abstract_inverted_index.prioritize	196
abstract_inverted_index.reporting,	245
abstract_inverted_index.resistance	3
abstract_inverted_index.system’s	233
abstract_inverted_index.Information	46
abstract_inverted_index.antibiogram	70, 253
abstract_inverted_index.application	167
abstract_inverted_index.color-coded	194
abstract_inverted_index.contributes	288
abstract_inverted_index.development	157
abstract_inverted_index.facilitated	240
abstract_inverted_index.generation.	254
abstract_inverted_index.guidelines,	141
abstract_inverted_index.information	124
abstract_inverted_index.integrating	126
abstract_inverted_index.integration	243
abstract_inverted_index.interfaces.	174
abstract_inverted_index.observation	55
abstract_inverted_index.open-source	122, 260
abstract_inverted_index.programming	168
abstract_inverted_index.reliability	87, 269
abstract_inverted_index.significant	7
abstract_inverted_index.stewardship	105, 265
abstract_inverted_index.antibiotics,	200
abstract_inverted_index.deficiencies	248
abstract_inverted_index.surveillance	18, 94, 230, 271
abstract_inverted_index.“Access”	199
abstract_inverted_index.Antimicrobial	2, 91, 137
abstract_inverted_index.Concentration	183
abstract_inverted_index.antimicrobial	13, 104, 264
abstract_inverted_index.capabilities.	231
abstract_inverted_index.compatibility	237
abstract_inverted_index.incorporating	161
abstract_inverted_index.surveillance.	209
abstract_inverted_index.user-friendly	234
abstract_inverted_index.Susceptibility	138
abstract_inverted_index.interpretation	192, 226
abstract_inverted_index.susceptibility	14
abstract_inverted_index.standardization	62
abstract_inverted_index.resource-limited	100, 273
abstract_inverted_index.standardization,	221
abstract_inverted_index.<title>METHODS</title>	112
abstract_inverted_index.<title>RESULTS</title>	212
abstract_inverted_index.<title>OBJECTIVE</title>	75
abstract_inverted_index.<title>BACKGROUND</title>	1
abstract_inverted_index.<title>CONCLUSIONS</title>	257
cited_by_percentile_year
countries_distinct_count	0
institutions_distinct_count	22
citation_normalized_percentile.value	0.44464016
citation_normalized_percentile.is_in_top_1_percent	False
citation_normalized_percentile.is_in_top_10_percent	False