Clinical Microbiology and Antimicrobial Chemotherapy. 2025; 27(3):369-389
To implement a closed digital loop for continuous antimicrobial resistance (AMR) surveillance based on validated microbiological diagnostic results.
A prospective study was conducted at the Federal State Autonomous Institution «National Medical Research Center for Treatment and Rehabilitation» of the Ministry of Health of the Russian Federation from May 2024 to September 2025. An audit of the initial state of processes, a SWOT analysis, software restructuring, data flow optimization and standardization of diagnostic methods in accordance with EUCAST recommendations were performed. An integrated digital system was implemented, including a Laboratory Information System (LIS) with a microbiological module, a Microbiological Reference and Information System (MRIS) and a Medical Information System (MIS). The evaluation of the implementation effectiveness included a comparative analysis of key processes before and after the project, an epidemiological analysis of AMR surveillance data accumulated within the loop, as well as a survey of physicians (n = 47) regarding their work with the modified microbiological report.
The established digital loop ensured the automation and standardization of microbiological diagnostic processes from sample registration to final report generation. The implementation of the MRIS allowed for the automation of expert evaluation and validation of antimicrobial susceptibility testing (AST) reports, as well as ensuring a stable, continuous flow of a structured dataset, including metadata related to microbiological diagnostic data. A transition was achieved from manual, episodic AMR surveillance to continuous, real-time digital analysis. Data accumulated within the loop as part of AMR surveillance were analyzed. The possibility of a prospective approach to surveillance without the need for manual data curation was demonstrated. Multifactorial data analysis aimed at finding correlations between the resistance of key pathogens and risk factor metadata was demonstrated. The use of expert comments in the new validated AST report for optimizing antimicrobial therapy was illustrated with a clinical case. The physician survey showed that 91.5% of respondents found such comments useful for making decisions on optimizing antimicrobial therapy.
The project implementation successfully overcame systemic shortcomings related to data fragmentation and a high reliance on manual labor. The integrated digital loop transformed the microbiological service into a center of expertise and AMR data analytics, providing a reliable basis for the development and timely adjustment of local empirical antimicrobial therapy guidelines.