Cross walk - 2021 form changes
ABCs
2021
ABCs Neonatal Infection Expanded Tracking Form
Current Form |
Proposed changes |
3C.
Gestational age determined by: 2=Physical Exam 3=Ultrasound 9=Unknown |
3C. Gestational age determined by: 1=Dates 2=Physical Exam 3=Ultrasound 4=Assisted Reproductive Technology 9=Unknown |
FoodNet
FoodNet Active Surveillance Data Elements List
Refer to Attachment #4 - Excel Spreadsheet – Changes are highlighted in Yellow
FoodNet Diagnostic Laboratory Practices and Volume Data Elements
Refer to Attachment #5 - Excel Spreadsheet - Changes are highlighted in Yellow
FluSurv-Net
FluSurv-NET Influenza Surveillance Project Case Report Form
Question on 2019-20 Form |
Question on 2020-21 Form |
(N/A) |
COVID-NET Case ID |
(N/A) |
RSV-NET Case ID |
(N/A) |
CDC Track |
C14. Where did patient reside at the time of hospitalization? (Indicate type of residence)
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C15. Where did patient reside at the time of hospitalization? (Indicate type of residence)
Other, specify |
(N/A) |
E2. BiPAP or CPAP use?
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(N/A) |
E3. High flow nasal cannula (e.g., Vapotherm)?
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(NA |
E6. Vasopressor use?
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(NA) |
E7. Renal Replacement Therapy (RRT) or Dialysis?
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K2a. If patient discharged alive, please indicate to where:
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F2. If patient discharged alive, please indicate to where:
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E7. Alcohol abuse
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(Deleted question) |
E8. Substance abuse
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(Deleted question) |
E8a. Substance Abuse Type (Current use only) check all that apply
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(Deleted question) |
E9. Current Non-Tobacco Smoker
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(Deleted question) |
E9. Current Non-Tobacco Smoker Type
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(Deleted question) |
(N/A)
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I1o. Hypertension
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E10f. Neuromuscular disorder
E10g. Neurologic disorder
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I1f. Neurologic Disorder
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E10m. Total # of pregnancies to date
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(Deleted question)
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E10m. Total # of pregnancies to date that resulted in a live birth
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(Deleted question)
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E10m. Specify total # of fetuses for current pregnancy
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(Deleted question)
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E10m. Specify gestational age in weeks |
(Deleted question)
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E10m. If gestation age in weeks unknown, specify trimester of pregnancy
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(Deleted question)
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G1. Were any bacterial culture tests performed with a collection date within three days of admission?
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(Deleted question) |
G2. If yes was there a positive culture for a bacterial pathogen?
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(Deleted question) |
G3a. If yes, specify Pathogen 1 |
(Deleted question) |
Gb. Date of culture |
(Deleted question) |
G3c. Site where pathogen identified
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(Deleted question) |
G3d. If Staphylococcus aureus, specify
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(Deleted question) |
H1b. Adenovirus
|
(Deleted question) |
H1b. Parainfluenza 1
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(Deleted question) |
H1b. Parainfluenza 2
|
(Deleted question) |
H1b. Parainfluenza 3
|
(Deleted question) |
H1b. Parainfluenza 4
|
(Deleted question) |
H1b. Human metapneumovirus
|
(Deleted question) |
H1b. Rhinovirus/Entervirus
|
(Deleted question) |
H1b. Coronavirus type
|
(Deleted question) |
(N/A) |
K1c. Coronavirus SARS-CoV-2
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2c. Total Duration (days) |
(Deleted question) |
M1. Was a chest x-ray taken within 3 days of hospitalization?
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(Deleted question) |
M2. Were any of these chest x-rays abnormal?
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(Deleted question) |
M2a. Date of first abnormal chest x-ray |
(Deleted question) |
M2b. For first abnormal chest x-ray, please check all that apply
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(Deleted question) |
K1. Did the patient have any of the following new diagnoses at discharge? (check all that apply)
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N1. Did the patient have any of the following new diagnoses at discharge? (check all that apply)
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FluSurv-NET/RSV Laboratory Survey
Question on 2019-20 form |
Question on 2020-21 form |
5a. Select kit name(s) (manufacturer) for all molecular assays performed at the laboratory: (Check all that apply) (https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html)
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5a. Select kit name(s) (manufacturer) for all molecular assays performed at the laboratory: (Check all that apply) (https://www.cdc.gov/flu/professionals/diagnosis/table-nucleic-acid-detection.html) Multiplex Assays Authorized for Simultaneous Detectiong of Influenza Viruses and SARS-CoV-2 by FDA: (https://www.cdc.gov/flu/professionals/diagnosis/table-flu-covid19-detection.html)
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5b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for molecular assay at the laboratory during the current influenza season.
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5b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for molecular assay at the laboratory during the current influenza season.
Other, specify |
5d. What testing kit does the testing facility use (or will use) most often to perform influenza A sub-typing during the current influenza season?
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5d. What testing kit does the testing facility use (or will use) most often to perform influenza A sub-typing during the current influenza season?
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8. Based on tests that were performed during the 2018-2019 influenza season, approximately what percent of the time are each of these test types used to test for flu overall?
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8. Based on tests that were performed during the 2019-2020 influenza season, approximately what percent of the time are each of these test types used to test for flu overall?
__% Standard Molecular Assay – multiplex /respiratory viral panel |
13a. Select kit name(s) (manufacturer) for all molecular assays used at the laboratory
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13a. Select kit name(s) (manufacturer) for all molecular assays used at the laboratory
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13b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for molecular assays at the laboratory during the current RSV season (select one)
|
13b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for molecular assays at the laboratory during the current RSV season (select one)
Other, specify |
18. Based on tests that were performed during the 2018-2019 RSV season, approximately what percent of the time are each of these test types used to test for RSV in pediatric patients (aged 0–17) years?
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18. Based on tests that were performed during the 2019-2020 RSV season, approximately what percent of the time are each of these test types used to test for RSV in pediatric patients (aged 0–17) years?
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19. Based on tests that were performed during the 2018-2019 RSV season, approximately what percent of the time are each of these test types used to test for RSV in adult patients (aged ≥18 years)?
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19. Based on tests that were performed during the 2019-2020 RSV season, approximately what percent of the time are each of these test types used to test for RSV in adult patients (aged ≥18 years)?
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HAIC
MuGSI Case Report Form for Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB)
Note: Changes on the 2021 CRF are highlighted in yellow.
Question on 2020 form |
Question on 2021 form |
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Title: 2020 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report |
Title: 2021 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report |
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11. Incident specimen collection site Blood Bone CSF Internal body site (specify):_____________ Joint/synovial fluid Muscle Peritoneal fluid Pericardial fluid Pleural fluid Urine Other normally sterile site (specify):______________ |
11. Incident specimen collection site Blood Bone Bronchoalveolar lavage (CRAB only, complete Q23c) CSF Internal body site (specify):_____________ Joint/synovial fluid Muscle Peritoneal fluid Pericardial fluid Pleural fluid Sputum (CRAB only, complete Q23c) Tracheal aspirate (CRAB only, complete Q23c) Urine Wound (specify):______________ (CRAB only) Other LRT site (specify):______________ (CRAB only, complete Q23c) Other normally sterile site (specify):______________ |
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11. Incident specimen collection site Abscess, not skin AV fistula/graft infection Bacteremia Bursitis Catheter site infection (CVC) Cellulitis Chronic ulcer/wound (not decubitus) Empyema Endocarditis Epidural abscess Meningitis Osteomyelitis Peritonitis Pneumonia Pyelonephritis Septic arthritis Septic emboli Septic shock Skin abscess Surgical incision infection Surgical site infection (internal) Traumatic wound Urinary tract infection Other (specify):_______________
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11. Incident specimen collection site Abscess, not skin AV fistula/graft infection Bacteremia Bursitis Catheter site infection (CVC) Cellulitis Chronic ulcer/wound (not decubitus) Empyema Endocarditis Epidural abscess Meningitis Osteomyelitis Peritonitis Pneumonia (CRAB cases, complete Q23c) Pyelonephritis Septic arthritis Septic emboli Septic shock Skin abscess Surgical incision infection Surgical site infection (internal) Traumatic wound Urinary tract infection Other (specify):_______________
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22d. Urine culture only: Was a blood culture positive in the 3 calendar days before through the 3 calendar days after the DISC for the same MuGSI organism? Yes No Unknown |
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25. Was the same organism (Q10) cultured from a different sterile site or urine in the 30 days after the DISC? Yes No Unknown If yes, source (check all that apply): Blood Bone CSF Internal body site (specify):_____________ Joint/synovial fluid Muscle Peritoneal fluid Pericardial fluid Pleural fluid Urine Other normally sterile site (specify):______________ |
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26. Enterobacteriaceae only: Were cultures of sterile site(s) or urine positive for a different organism (Q10) in the 30 days before the DISC? Yes No Unknown N/A If yes, source (check all that apply): Blood Bone CSF Internal body site (specify):_____________ Joint/synovial fluid Muscle Peritoneal fluid Pericardial fluid Pleural fluid Urine Other normally sterile site (specify):______________
If yes, indicate organism and associated state ID for the incident closest to the DISC: Escherichia coli Enterobacter cloacae Klebsiella aerogenes Klebsiella pneumoniae Klebsiella oxytoca |
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27a. A. baumannii cultures only: Was cultures of other sterile site(s) or urine positive for another A. baumannii in in the 30 days after the DISC? Yes No Unknown N/A If yes, source (check all that apply): Blood Bone CSF Internal body site (specify):_____________ Joint/synovial fluid Muscle Peritoneal fluid Pericardial fluid Pleural fluid Urine Other normally sterile site (specify):______________ If yes, state ID for the incident case closest to the DISC:________ |
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27b. A. baumannii cultures only: Did the patient have a sputum culture positive for CRAB in the 30 days before the DISC? Yes No Unknown N/A |
23a. A. baumannii cultures only: Did the patient have a sputum culture positive for CRAB in the 30 days before the DISC? Yes No Unknown N/A |
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27c. A. baumannii cultures only: Risk factors in the 7 days before the DISC Non-invasive positive pressure ventilation (CPAP or BiPAP) at any time in the 7 calendar days before the DISC Nebulizer treatment at any time in the 7 calendar days before the DISC Mechanical ventilation at any time in the 7 calendar days before the DISC |
23b. A. baumannii cultures only: Risk factors in the 7 days before the DISC Non-invasive positive pressure ventilation (CPAP or BiPAP) at any time in the 7 calendar days before the DISC Nebulizer treatment at any time in the 7 calendar days before the DISC Mechanical ventilation at any time in the 7 calendar days before the DISC |
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Complete question 23c ONLY for A. baumannii cases from LRT site cultures or for non-LRT cultures where pneumonia is marked in question 17a.
23c. Chest Radiology Findings (check all that apply): Not done No report available Acute respiratory distress syndrome (ARDS) Air Space density/opacity Ground glass opacities/infiltrates Bronchopneumonia/pneumonia Cannot rule out pneumonia Cavitation Consolidation Infiltrate Pleural effusion Nodules |
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28a. Was the patient positive for the same organism in the year before the DISC? Yes No Unknown |
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28b. If yes, specify date of culture and state ID for the first positive culture in the year before: Date of culture: __/__/____ State ID:_________ |
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29a. Enterobacteriaceae only: Was the patient positive for a MuGSI Enterobacteriaceae in the year before the DISC? Yes No Unknown |
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29b. If yes, specify organism, date of culture, and state ID for the first positive Enterobacteriaceae culture in the year before the DISC: Escherichia coli Enterobacter cloacae Klebsiella aerogenes Klebsiella pneumoniae Klebsiella oxytoca
Date of culture: __/__/____
State ID:_______________
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30a. Did the patient have a positive test(s) for SARS-Cov-2 (molecular assay, serology or other confirmatory test) on or before the DISC? Yes No Unknown |
24a. Did the patient have a positive test(s) for SARS-Cov-2 (molecular assay, serology or other confirmatory test) on or before the DISC? Yes No Unknown |
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30b. If yes, complete table below
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24b. If yes, complete table below
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30c. COVID-NET Case ID:_______________ |
24c. COVID-NET Case ID:_______________ |
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30d. NNDSS IDs (Please provide at least one of the following when applicable): Local Case ID: _____________ Local Record ID: _____________ State Case Identifier: _____________ Legacy Case Identifier: _____________ |
24d. NNDSS IDs (Please provide at least one of the following when applicable): Local Case ID: _____________ Local Record ID: _____________ State Case Identifier: _____________ Legacy Case Identifier: _____________ CDC 2019-nCOV ID: _____________ |
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23. Was the incident specimen polymicrobial? Yes No Unknown |
25. Was the incident specimen polymicrobial? Yes No Unknown |
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24a. Was the incident specimen tested for carbapenemase? Yes No Laboratory not testing Unknown |
26a. Was the incident specimen tested for carbapenemase? Yes No Laboratory not testing Unknown |
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24b. If yes, what testing method was used (check all that apply) Non-Molecular Tests: CarbaNP Carbapenemase Inactivation Method (CIM) Disk Diffusion/ROSCO Disk E-test Modified Carbapenemase Inactivation Method (mCIM) Modified Hodge Test (MHT) RAPIDEC Other (specify):_______________ Unknown Molecular Tests: Automated Molecular Assay Carba-R Check Points MALDI-TOF MS Next Generation Nucleic Acid Sequencing PCR Streck ARM-D Other (specify):________________ Unknown |
26b. If yes, what testing method was used (check all that apply) Non-Molecular Tests: CarbaNP Carbapenemase Inactivation Method (CIM) Disk Diffusion/ROSCO Disk E-test Modified Carbapenemase Inactivation Method (mCIM) Modified Hodge Test (MHT) RAPIDEC Other (specify):_______________ Unknown Molecular Tests: Automated Molecular Assay Carba-R Check Points MALDI-TOF MS Next Generation Nucleic Acid Sequencing PCR Streck ARM-D Other (specify):________________ Unknown |
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24c. IF TESTED, WHAT WAS THE TESTING RESULT? Non-Molecular Test Results: □ Positive □ Negative □ Indeterminate □ Unknown Molecular Test Results:
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26c. IF TESTED, WHAT WAS THE TESTING RESULT? Non-Molecular Test Results: □ Positive □ Negative □ Indeterminate □ Unknown Molecular Test Results:
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31. Susceptibility results
Antibiotic Amikacin Amoxicillin/Clavulanate Ampicillin Ampicillin/Sulbactam Aztreonam Cefazolin Cefepime Cefotaxime Cefoxitin Ceftazidime Ceftazidime/Avibactam Ceftolozane/Tazobactam Ceftriaxone Cephalothin Ciprofloxacin Colistin Doripenem Doxycycline Ertapenem Fosfomycin Gentamicin Imipenem Imipenem-relebactam Levofloxacin Meropenem Meropenem-vaborbactam Minocycline Nitrofurantoin Piperacillin/Tazobactam Plazomicin Polymyxin B Rifampin Tetracycline Tigecycline Tobramycin Trimethoprim-sulfamethoxazole
Data source Medical record Microscan Vitek Phoenix Kirby-Bauer E-test |
27. Susceptibility results
Antibiotic Amikacin Amoxicillin/Clavulanate Ampicillin Ampicillin/Sulbactam Aztreonam Cefazolin Cefepime Cefiderocol Cefotaxime Cefoxitin Ceftazidime Ceftazidime/Avibactam Ceftolozane/Tazobactam Ceftriaxone Cephalothin Ciprofloxacin Colistin Doripenem Doxycycline Eravacycline Ertapenem Fosfomycin Gentamicin Imipenem Imipenem-relebactam Levofloxacin Meropenem Meropenem-vaborbactam Minocycline Nitrofurantoin Omadacycline Piperacillin/Tazobactam Plazomicin Polymyxin B Rifampin Tetracycline Tigecycline Tobramycin Trimethoprim-sulfamethoxazole
Data source Medical record Microscan Vitek Phoenix Sensititre Kirby-Bauer E-test |
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32a. Was case first identified through audit? Yes No |
28a. Was case first identified through audit? Yes No |
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32b. CRF status Complete Pending Chart unavailable after 3 requests |
28b. CRF status Complete Pending Chart unavailable after 3 requests |
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28c. SO Initials: __________________ |
28c. SO Initials: __________________ |
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31d. Date of abstraction: ___ ___ - ___ ___ - ___ ___ ___ ___
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28d. Date of abstraction: ___ ___ - ___ ___ - ___ ___ ___ ___
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31e. Comments: __________________________________ ______________________ |
28e. Comments: __________________________________ _________________________________________________
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Multi-site Gram-Negative Surveillance Initiative (MuGSI)- Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL)
Note: Changes on the 2021 CRF are highlighted in yellow.
Question on 2020 form |
Question on 2021 form |
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Title: 2020 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report |
Title: 2021 Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacteriaceae Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report |
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26a. Is antimicrobial use (IV or oral) in the 30 days before the DISC documented? Yes No Unknown |
24a. Is antimicrobial use (IV or oral) in the 30 days before the DISC documented? Yes No Unknown |
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26b. If yes, check all antimicrobials used in the 30 days before the DISC □ Amikacin □ Amoxicillin □ Amoxicillin/clavulanic acid □ Ampicillin □ Ampicillin/sulbactam □ Azithromycin □ Aztreonam □ Cefazolin □ Cefdinir □ Cefepime □ Cefixime □ Cefotaxime □ Cefoxitin □ Cefpodoxime □ Ceftaroline □ Ceftazidime □ Ceftazidime/avibactam □ Ceftizoxime □ Ceftolozane/tazobactam □ Ceftriaxone □ Cefuroxime □ Cephalexin □ Ciprofloxacin □ Clarithromycin □ Clindamycin □ Dalbavancin □ Daptomycin □ Delafloxacin □ Doripenem □ Doxycycline □ Ertapenem □ Fidaxomicin □ Fosfomycin □ Gentamicin □ Imipenem/cilastatin □ Levofloxacin □ Linezolid □ Meropenem □ Meropenem/vaborbactam □ Metronidazole □ Moxifloxacin □ Nitrofurantoin □ Oritavancin □ Penicillin □ Piperacillin/tazobactam □ Polymyxin B □ Polymyxin E (colistin) □ Rifaximin □ Tedizolid □ Telavancin □ Tigecycline □ Tobramycin □ Trimethoprim □ Trimethoprim/sulfamethoxazole □ Vancomycin IV PO □ Other (specify): _____________________ □ Other (specify): _____________________ |
24b. If yes, check all antimicrobials used in the 30 days before the DISC □ Amikacin □ Amoxicillin □ Amoxicillin/clavulanic acid □ Ampicillin □ Ampicillin/sulbactam □ Azithromycin □ Aztreonam □ Cefazolin □ Cefdinir □ Cefepime □ Cefiderocol □ Cefixime □ Cefotaxime □ Cefoxitin □ Cefpodoxime □ Ceftaroline □ Ceftazidime □ Ceftazidime/avibactam □ Ceftizoxime □ Ceftolozane/tazobactam □ Ceftriaxone □ Cefuroxime □ Cephalexin □ Ciprofloxacin □ Clarithromycin □ Clindamycin □ Dalbavancin □ Daptomycin □ Delafloxacin □ Doripenem □ Doxycycline □ Ertapenem □ Eravacycline □ Fidaxomicin □ Fosfomycin □ Gentamicin □ Imipenem/cilastatin □ Levofloxacin □ Linezolid □ Meropenem □ Meropenem/vaborbactam □ Metronidazole □ Moxifloxacin □ Nitrofurantoin □ Omadacycline □ Oritavancin □ Penicillin □ Piperacillin/tazobactam □ Polymyxin B □ Polymyxin E (colistin) □ Rifaximin □ Tedizolid □ Telavancin □ Tigecycline □ Tobramycin □ Trimethoprim □ Trimethoprim/sulfamethoxazole □ Vancomycin IV PO □ Other (specify): _____________________ □ Other (specify): _____________________ |
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24a. Did the patient have a positive test(s) for SARS-Cov-2 (molecular assay, serology or other confirmatory test) on or before the DISC? Yes No Unknown |
25a. Did the patient have a positive test(s) for SARS-Cov-2 (molecular assay, serology or other confirmatory test) on or before the DISC? Yes No Unknown |
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24b. If yes, complete table below
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25b. If yes, complete table below
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24c. COVID-NET Case ID: _____________ |
25c. COVID-NET Case ID: _____________ |
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24d. NNDSS IDs (Please provide at least one of the following when applicable): Local Case ID: _____________ Local Record ID: _____________ State Case Identifier: _____________ Legacy Case Identifier: _____________ |
25d. NNDSS IDs (Please provide at least one of the following when applicable): Local Case ID: _____________ Local Record ID: _____________ State Case Identifier: _____________ Legacy Case Identifier: _____________ CDC 2019-nCOV ID: _____________ |
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25a. Was the incident specimen polymicrobial? Yes No Unknown |
26a. Was the incident specimen polymicrobial? Yes No Unknown |
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25b. What screening/confirmatory method was used for ESBL identification? None Unknown Broth microdilution (ATI detection) ESBL well Expert rule (ATI flag) Unknown Broth Microdilution (Manual) Disk Diffusion E-test Molecular test (specify) Other non-molecular test (specify) |
26b. What screening/confirmatory method was used for ESBL identification? None Unknown Broth microdilution (ATI detection) ESBL well Expert rule (ATI flag) Unknown Broth Microdilution (Manual) Disk Diffusion E-test Molecular test (specify) Other non-molecular test (specify) |
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25c. If screening/confirmatory method was used, what was the result? Positive Negative Indeterminate Unknown
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26c. If screening/confirmatory method was used, what was the result? Positive Negative Indeterminate Unknown
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27. Susceptibility results
Antibiotic Amikacin Amoxicillin/Clavulanate Ampicillin Ampicillin/Sulbactam Aztreonam Cefazolin Cefepime Cefotaxime Cefoxitin Ceftazidime Ceftazidime/Avibactam Ceftolozane/Tazobactam Ceftriaxone Cephalothin Ciprofloxacin Colistin Doripenem Doxycycline Ertapenem Fosfomycin Gentamicin Imipenem Imipenem-relebactam Levofloxacin Meropenem Meropenem-vaborbactam Minocycline Nitrofurantoin Piperacillin/Tazobactam Plazomicin Polymyxin B Rifampin Tetracycline Tigecycline Tobramycin Trimethoprim-sulfamethoxazole
Data source Medical record Microscan Vitek Phoenix Kirby-Bauer E-test |
27. Susceptibility results
Antibiotic Amikacin Amoxicillin/Clavulanate Ampicillin Ampicillin/Sulbactam Aztreonam Cefazolin Cefepime Cefiderocol Cefotaxime Cefoxitin Ceftazidime Ceftazidime/Avibactam Ceftolozane/Tazobactam Ceftriaxone Cephalothin Ciprofloxacin Colistin Doripenem Doxycycline Eravacycline Ertapenem Fosfomycin Gentamicin Imipenem Imipenem-relebactam Levofloxacin Meropenem Meropenem-vaborbactam Minocycline Nitrofurantoin Omadacycline Piperacillin/Tazobactam Plazomicin Polymyxin B Rifampin Tetracycline Tigecycline Tobramycin Trimethoprim-sulfamethoxazole
Data source Medical record Microscan Vitek Phoenix Sensititre Kirby-Bauer E-test |
Invasive MRSA Infection Case Report Form
2020 Paper CRF Question |
Changes to the 2020 Paper CRF Question |
34a. NNDSS IDs (please provide at least one of the following when applicable): Local case ID:_____________ Local record ID:___________ State case Identifier:________ Legacy case identifier:_____________ |
34a. NNDSS IDs (please provide at least one of the following when applicable): CDC 2019 NCOV ID:_____________ (new data collection) Local case ID:_______________ Local record ID:________________ State case Identifier:______________ Legacy case identifier:_____________ |
Invasive MSSA Infections Case Report Form
2020 Paper CRF Question |
Changes to the 2020 Paper CRF Question |
34a. NNDSS IDs (please provide at least one of the following when applicable): Local case ID:_____________ Local record ID:___________ State case Identifier:________ Legacy case identifier:_____________ |
34a. NNDSS IDs (please provide at least one of the following when applicable): CDC 2019 NCOV ID:_____________ (new data collection) Local case ID:_______________ Local record ID:________________ State case Identifier:______________ Legacy case identifier:_____________ |
CDI Case Report Form and Treatment Form
2020 CRF |
2021 CRF |
9. Positive diagnostic assay for C.diff |
9. Diagnostic assay for C.diff (Reworded question. Change was noted on last year’s application but mistakenly not changed on the CRF. Response options remain the same)
|
40a. FIRST positive test for SARS-CoV-2 on or before the DISC – Test type
|
40a. FIRST positive test for SARS-CoV-2 on or before the DISC – Test type
(Added antigen as a response option, previously captured as “other”) |
40a. Most recent positive test for SARS-CoV-2 on or before the DISC – Test type
|
40a. Most recent positive test for SARS-CoV-2 on or before the DISC – Test type
(Added antigen as a response option, previously captured as “other”) |
41b. NNDSS IDs (please provide at least one of the following when applicable): Local Case ID: Local Record ID: State case identifier: Legacy case identifier: |
41b. NNDSS IDs (please provide at least one of the following when applicable): Local Case ID: Local Record ID: State case identifier: Legacy case identifier: CDC 2019-nCOV ID: (Added one more NNDSS ID) |
Annual Survey of Laboratory Testing Practices for C. difficile Infections
Existing question |
Modified question |
[Section 1] Was this lab audited in 2019? |
[Section 1] Was this lab audited in 2020? (changed year to 2020 to reflect change in survey year) |
[Section 2] 5. What are the testing codes associated with the tests your lab currently uses? |
[Section 2] 5. What are the LOINC or internal testing codes associated with the tests your lab currently uses (e.g. LOINC codes 13957-6, 34713-8, or 54067-4)? (Clarified that we’re asking for LOINC or internal testing codes; added examples of LOINC codes) |
[Section 2] 6. Has your lab testing algorithm for C. difficile changed since January 1, 2019?
|
[Section 2] 6. Has your lab testing algorithm for C. difficile changed since January 1, 2020? (changed year to 2020 to reflect change in survey year) |
[Section 2] 7a. Has your rejection policy for stool specimens changed since January 1, 2019? |
[Section 2] 7a. Has your rejection policy for stool specimens changed since January 1, 2020? (changed year to 2020 to reflect change in survey year) |
HAIC Candidemia Case Report
2020 CRF Question |
2021 CRF Question |
||||||||||||||||||||||||||||||||||||||
CANDIDEMIA 2020 CASE REPORT FORM (header)
|
CANDIDEMIA 2021 CASE REPORT FORM (header) (changed year) |
||||||||||||||||||||||||||||||||||||||
Version: Short Form 2020, Last Updated: 07/9/2019 (footnotes)
|
Version: Short Form 2021, Last Updated: 07/21/2020 (footnotes) (changed year and date) |
||||||||||||||||||||||||||||||||||||||
25. Antifungal susceptibility testing (check here if no testing done/no test reports available):
|
25. Antifungal susceptibility testing (check here if no testing done/no test reports available):
(removed “NS” as an option)
|
||||||||||||||||||||||||||||||||||||||
26. Additional non-Candida organisms isolated from blood cultures on the day of or in the 6 days before the DISC:
1 Yes 0 No 9 Unknown
|
29. Additional non-Candida organisms isolated from blood cultures on the day of or in the 6 days before the DISC:
1 Yes 0 No 9 Unknown
(changed question number) |
||||||||||||||||||||||||||||||||||||||
26a. If yes, additional organisms (Enter up to 3 pathogens): ____________________, ____________________, ____________________
|
29a. If yes, additional organisms (Enter up to 3 pathogens): ____________________, ____________________, ____________________
(changed question number) |
||||||||||||||||||||||||||||||||||||||
27. Infection with Clostridioides difficile in the 90 days before or 30 days after the DISC:
1 Yes 0 No 9 Unknown |
30. Infection with Clostridioides difficile on the day of or in the 89 days before or 29 days after the DISC:
1 Yes 0 No 9 Unknown
(changed question number and updated wording) |
||||||||||||||||||||||||||||||||||||||
27a. If yes, date of first C. diff diagnosis: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown
|
30a. If yes, date of first C. diff diagnosis: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown
(changed quesiton number) |
||||||||||||||||||||||||||||||||||||||
28. Any subsequent positive Candida blood cultures in the 29 days after, not including the DISC?
1 Yes 0 No 9 Unknown |
26. Any subsequent positive Candida blood cultures in the 29 days after, not including the DISC?
1 Yes 0 No 9 Unknown
(changed question number) |
||||||||||||||||||||||||||||||||||||||
28a. If yes, provide dates of all subsequent positive Candida blood cultures and select the species:
|
26a. If yes, provide dates of all subsequent positive Candida blood cultures and select the species:
(changed question number) |
||||||||||||||||||||||||||||||||||||||
29. Documented negative Candida blood culture on the day of or in the 29 days after the DISC?
1 Yes 0 No 9 Unknown
|
27. Documented negative Candida blood culture on the day of or in the 29 days after the DISC (in which no blood cultures after this negative culture were positive in the 29 days after the DISC)?
1 Yes 0 No 9 Unknown
(changed question number and updated the wording) |
||||||||||||||||||||||||||||||||||||||
29a. If yes, date of negative blood culture: ___ ___ - ___ ___ - ___ ___ ___ ___
|
27a. If yes, date of negative blood culture: ___ ___ - ___ ___ - ___ ___ ___ ___
(changed question number) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
28. On the day of or in the 6 days before the DISC, was the patient known to be colonized with or being managed as if they were colonized with a multi-drug resistant organism (MDRO) (e.g., on contact precautions)? MDROs include CRE, CRPA, CRAB, MRSA, and VRE. 1 Yes 0 No 9 Unknown
(new data collection) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
28a. If yes, specify organisms (Enter up to 3 pathogens): ____________________, ____________________, ____________________
(new data collection) |
||||||||||||||||||||||||||||||||||||||
30. Did the patient have any of the following types of infection/colonization related to their Candida infection? (check all that apply): None Unknown
Abscess Splenic Liver Pulmonary Other (specify): _____________ Candiduria CNS involvement (meningitis, brain abscess) Eyes (endophthalmitis or chorioretinitis) Endocarditis Peritonitis Respiratory specimen with Candida Septic emboli Lungs Brain Osteomyelitis Skin lesions Other (specify): ______________________ |
31. Did the patient have any of the following types of infection/colonization related to their Candida infection? (check all that apply): None Unknown
Abdominal (new data collection) Hepatobiliary or pancreatic (new data collection) GI tract (new data collection) Abscess (specify): _________ (new data collection) Peritonitis/peritoneal fluid (new data collection) Splenic (new data collection) Candiduria Esophagitis (new data collection) Oral/thrush (new data collection) Osteomyelitis Skin lesions/wounds Pulmonary (new data collection) Abscess (new data collection) Respiratory specimen with Candida (new data collection) CNS involvement (meningitis, brain abscess) Eyes (endophthalmitis or chorioretinitis) Endocarditis Septic emboli (specify location): _________ (new data collection) Other (specify): __________
(changed question number, reorganized response options, removed some response options, new data collection for some response options) |
||||||||||||||||||||||||||||||||||||||
31. Was the patient hospitalized on the day of or in the 6 days after the DISC?
1 Yes 0 No 9 Unknown |
32. Was the patient hospitalized on the day of or in the 6 days after the DISC?
1 Yes 0 No 9 Unknown
(changed question number) |
||||||||||||||||||||||||||||||||||||||
31a. If yes, Date of first admission: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown
Hospital ID: _________________ Unknown
|
32a. If yes, Date of first admission: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown
Hospital ID: _________________ Unknown
(changed question number) |
||||||||||||||||||||||||||||||||||||||
31b. Was the patient transferred during this hospitalization? 1 Yes 0 No 9 Unknown
If yes, enter up to two transfers: Date of transfer: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown Hospital ID: _________________ Unknown
Date of second transfer: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown Hospital ID: _________________ Unknown
|
32b. Was the patient transferred during this hospitalization? 1 Yes 0 No 9 Unknown
If yes, enter up to two transfers: Date of transfer: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown Hospital ID: _________________ Unknown
Date of second transfer: ___ ___ - ___ ___ - ___ ___ ___ ___ Unknown Hospital ID: _________________ Unknown
(changed question number) |
||||||||||||||||||||||||||||||||||||||
32. Where was the patient located prior to admission?
1 Private residence 3 LTCF Facility ID: ____________ 4 LTACH Facility ID: _____________ 5 Homeless 6 Incarcerated 7 Other (specify): ______________________ 9 Unknown
|
32c. Where was the patient located prior to admission or, if not hospitalized, where was the patient located on the 3rd calendar day before the DISC? (Check one)
1 Private residence 2 Hospital inpatient (new option) Facility ID: ___________ 3 LTCF Facility ID: ____________ 4 LTACH Facility ID: _____________ 5 Homeless 6 Incarcerated 7 Other (specify): ______________________ 9 Unknown
(changed question number, clarified the wording of the question and added a new location option) |
||||||||||||||||||||||||||||||||||||||
40. Underlying conditions (Check all that apply):
Chronic Lung Disease Cystic Fibrosis Chronic Pulmonary disease Chronic Metabolic Disease Diabetes Mellitus With Chronic Complications Cardiovascular Disease CVA/Stroke/TIA Congenital Heart disease Congestive Heart Failure Myocardial infarction Peripheral Vascular Disease (PVD) Gastrointestinal Disease Diverticular disease Inflammatory Bowel Disease Peptic Ulcer Disease Short gut syndrome Immunocompromised Condition HIV infection AIDS/CD4 count <200 Primary Immunodeficiency Transplant, Hematopoietic Stem Cell Transplant, Solid Organ Liver Disease Chronic Liver Disease Ascites Cirrhosis Hepatic Encephalopathy Variceal Bleeding Hepatitis C Treated, in SVR Current, chronic Malignancy Malignancy, Hematologic Malignancy, Solid Organ (non-metastatic) Malignancy, Solid Organ (metastatic) Neurologic Condition Cerebral palsy Chronic Cognitive Deficit Dementia Epilepsy/seizure/seizure disorder Multiple sclerosis Neuropathy Parkinson’s disease Other (specify): _________________ Plegias/Paralysis Hemiplegia Paraplegia Quadriplegia Renal Disease Chronic Kidney Disease Lowest serum creatinine: ______________mg/DL Unknown or not done Skin Condition Burn Decubitus/Pressure Ulcer Surgical Wound Other chronic ulcer or chronic wound Other (specify): _________________ Other Connective tissue disease Obesity or morbid obesity Pregnant
|
40. Underlying conditions (Check all that apply):
Chronic Lung Disease Cystic Fibrosis Chronic Pulmonary disease Chronic Metabolic Disease Diabetes Mellitus With Chronic Complications Cardiovascular Disease CVA/Stroke/TIA Congenital Heart disease Congestive Heart Failure Myocardial infarction Peripheral Vascular Disease (PVD) Gastrointestinal Disease Diverticular disease Inflammatory Bowel Disease Peptic Ulcer Disease Short gut syndrome Immunocompromised Condition HIV infection AIDS/CD4 count <200 Primary Immunodeficiency Transplant, Hematopoietic Stem Cell Transplant, Solid Organ Liver Disease Chronic Liver Disease Ascites Cirrhosis Hepatic Encephalopathy Variceal Bleeding Hepatitis B, chronic (new option) Hepatitis C Treated, in SVR Current, chronic Hepatitis B, acute (new option) Malignancy Malignancy, Hematologic Malignancy, Solid Organ (non-metastatic) Malignancy, Solid Organ (metastatic) Neurologic Condition Cerebral palsy Chronic Cognitive Deficit Dementia Epilepsy/seizure/seizure disorder Multiple sclerosis Neuropathy Parkinson’s disease Other (specify): _________________ Plegias/Paralysis Hemiplegia Paraplegia Quadriplegia Renal Disease Chronic Kidney Disease Lowest serum creatinine: ______________mg/DL Unknown or not done Skin Condition Burn Decubitus/Pressure Ulcer Surgical Wound Other chronic ulcer or chronic wound Other (specify): _________________ Other Connective tissue disease Obesity or morbid obesity Pregnant
(added 2 new options for hepatitis indication under ‘liver disease’) |
||||||||||||||||||||||||||||||||||||||
47. Surgeries on the day of or in the 89 days before the DISC:
Abdominal surgery Non-abdominal surgery (specify): __________________ No surgery |
47. Surgeries in the 90 days before, not including the DISC:
Abdominal surgery (specify): _________________ If yes: 1 Open abdomen 0 Laparoscopic 9 Unknown Non-abdominal surgery (specify): __________________ No surgery
(changed the question wording, added specification for “Abdominal surgery” and check box options under “Abdominal surgery” which is a new data collection) |
||||||||||||||||||||||||||||||||||||||
48. Pancreatitis on the day of or in the 89 days before the DISC:
1 Yes 0 No 9 Unknown |
48. Pancreatitis in the 90 days before, not including the DISC:
1 Yes 0 No 9 Unknown
(changed the question wording) |
||||||||||||||||||||||||||||||||||||||
49a. If yes, did the patient have any urinary tract procedures on the day of or in the 89 days before the DISC?
1 Yes 0 No 9 Unknown |
49a. If yes, did the patient have any urinary tract procedures in the 90 days before, not including the DISC?
1 Yes 0 No 9 Unknown
(changed the question wording) |
||||||||||||||||||||||||||||||||||||||
53. Did the patient have any of the following indwelling devices present in the 2 calendar days before, not including the DISC?
None Unknown Urinary Catheter/Device Indwelling urethral Suprapubic Respiratory ET/NT Tracheostomy Gastrointestinal Abdominal drain (specify): _________________ Gastrostomy |
53. Did the patient have any of the following indwelling devices or other devices present in the 2 calendar days before, not including the DISC?
None Unknown Urinary Catheter/Device Indwelling urethral Suprapubic Respiratory ET/NT Tracheostomy Invasive mechanical ventilation (new data collection) Gastrointestinal Abdominal drain (specify): _________________ Gastrostomy
(changed question wording, added a check box for this question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
55. Did the patient receive any systemic steroids in the 30 days before, not including the DISC?
1 Yes 0 No 9 Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
55. Did the patient receive total parenteral nutrition (TPN) in the 14 days before, not including the DISC?
1 Yes 0 No 9 Unknown
|
56. Did the patient receive total parenteral nutrition (TPN) in the 14 days before, not including the DISC?
1 Yes 0 No 9 Unknown
(changed the question number) |
||||||||||||||||||||||||||||||||||||||
56. Did the patient receive systemic antifungal medication on the day of or in the 13 days before the DISC?
1 Yes (if Yes, fill out question 59) 0 No 9 Unknown
|
57. Did the patient receive systemic antifungal medication on the day of or in the 13 days before the DISC?
1 Yes (if Yes, fill out question 60) 0 No 9 Unknown
(changed the question number) |
||||||||||||||||||||||||||||||||||||||
57. Was the patient administered systemic antifungal medication after, not including the DISC?
1 Yes (if Yes, fill out question 59) 0 No 9 Unknown
|
58. Was the patient administered systemic antifungal medication after, not including the DISC?
1 Yes (if Yes, fill out question 60) 0 No 9 Unknown
(changed the question number) |
||||||||||||||||||||||||||||||||||||||
58. If antifungal medication was not given to treat current candidemia infection, what was the reason?
1 Patient died before culture result available to clinicians 2 Comfort care only measures were instituted 3 Patient discharged before culture result available to clinician 4 Medical records indicated culture result not clinically significant 5 Other reason documented in medical records, specify: ______________ 6 Patient refused treatment against medical advice 9 Unknown |
59. If antifungal medication was not given to treat current candidemia infection, what was the reason?
1 Patient died before culture result available to clinicians 2 Comfort care only measures were instituted 3 Patient discharged before culture result available to clinician 4 Medical records indicated culture result not clinically significant or contaminated 5 Other reason documented in medical records, specify: ______________ 6 Patient refused treatment against medical advice 9 Unknown
(changed question number, added additional clarification to one response) |
||||||||||||||||||||||||||||||||||||||
59. ANTIFUNGAL MEDICATION
|
60. ANTIFUNGAL MEDICATION
(changed question number) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
61. Does the chart indicate that the incident specimen was considered a contaminant or was considered to not be indicative of true of infection?
1 Yes 0 No 9 Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
62. Was the patient under the care of an infectious disease physician on the day of the DISC or within the 6 days after the DISC?
1 Yes 0 No 9 Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
1. Did the patient have a positive SARS-CoV-2 test result (molecular assay, serology, or other confirmatory test) from a specimen collected in the 30 days before the DISC or on the DISC?
1 Yes 0 No 9 Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
1a. If yes, date of specimen collection for initial positive SARS-CoV-2 test:
Date: ________ 9 Date Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
1b. If yes, EIP COVID-NET Case ID: ____________ 9 Unknown Out of EIP COVID-NET catchment area
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
2. Did the patient receive invasive mechanical ventilation in the 30 days before the DISC, not including the DISC?
1 Yes 0 No 9 Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
3. Did the patient receive dialysis or renal replacement therapy (RRT) in the 30 days before the DISC, not including the DISC?
1 Yes 0 No 9 Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
4. If patient received any systemic steroids in the 30 days before the DISC, not including the DISC (question 55), are any of the following scenarios true? (check all that apply) Steroid(s) given as an outpatient medication Steroid(s) given during hospitalization associated with candidemia episode prior to Candida DISC Steroid(s) given as part of treatment/management for COVID-19
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
5. Did the patient receive any of the following immunomodulatory drugs in the 30 days before the DISC, not including the DISC? (check all that apply)
None Tocilizumab Sarilumab Baricitinib Unknown
(new question) |
||||||||||||||||||||||||||||||||||||||
New question for 2021 |
5a. If yes (and patient had a positive SARS-CoV-2 test), were any of the immunomodulatory drugs given as part of treatment/management for COVID-19?
1 Yes 0 No 9 Unknown
(new question) |
Laboratory Testing Practices for Candidemia Questionnaire
2020 CRF Question |
2021 CRF Question |
2020 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE (header)
|
2021 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE (header)
(changed year) |
New Question |
Yes No (----- If No, SKIP TO QUESTION 15 -----) Unknown (is there another laboratory staff member who can assist with the questionnaire?)
(new data collection) |
New Question |
On-site, in the laboratory Sent to commercial lab Sent to affiliated hospital lab Sent to other local/regional, non-affiliated reference or public health laboratory Other ______________________________ Unknown
(new data collection) |
New Instructions |
Answer the following questions for the lab selected in question 8. |
7) How does your lab identify yeast? (check all that apply) MALDI-TOF Bruker (Biotyper) MALDI-TOF bioMerieux (VITEK MS) VITEK 2 API 20C DNA sequencing PNA-FISH BactiCard Candida BD Phoenix MicroScan RapID Plus Other (specify) ______________________ Unknown |
MALDI-TOF Bruker (Biotyper) MALDI-TOF bioMerieux (VITEK MS) VITEK 2 API 20C DNA sequencing PNA-FISH BactiCard Candida BD Phoenix MicroScan RapID Plus Other (specify) ______________________ Unknown
(changed question number, updated question wording) |
8) Does your laboratory routinely use Chromagar for the identification or differentiation of Candida isolates? Yes No Unknown |
Yes No Unknown
(changed question number, updated question wording) |
9) Species-level identification is performed for Candida spp. isolated from which of the following?
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
|
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
Yes, reflexively Yes, with clinician order No Unknown
(changed question number) |
10) Does your laboratory employ the T2Candida Panel to identify Candida from blood specimens? Yes (go to 10a) No (go to 11) Unknown
Yes, reflexively Yes, with a clinical order No Unknown |
Yes (go to 12a) No (go to 13) Unknown
Yes, reflexively Yes, with a clinical order No Unknown (changed question number, updated question wording, updated question numbers for proper skip logic in response options) |
11) Does your laboratory employ the BioFire (FilmArray) to identify Candida from blood culture? Yes (go to 11a) No (go to 12) Unknown
Yes, reflexively Yes, with a clinical order No Unknown |
Yes (go to 13a) No (go to 14) Unknown
(Deleted 11b)
(changed question number, updated question wording, updated question numbers for proper skip logic in response options, removed sub-question 11b) |
12) If No for both Question 10 and 11, does this laboratory have plans to employ culture-independent diagnostics for Candida identification in the near future (e.g. T2Candida Panel, BioFire)? Yes No Unknown Not applicable (Yes to Q17 or Q18) |
Yes No Unknown Not applicable
(changed question number, updated question wording, updated response wording for ‘not applicable’) |
13) Does your laboratory offer any antifungal susceptibility testing for Candida? Yes (Continue onto Page 2) No (-- If No, QUESTIONNAIRE COMPLETE---) Unknown (is there another laboratory staff member who can assist with the questionnaire?)
|
Yes No (-- If No, QUESTIONNAIRE COMPLETE---) Unknown (is there another laboratory staff member who can assist with the questionnaire?)
(changed question number, updated question wording, updated response wording for ‘yes’) |
14) Where is antifungal susceptibility testing (AFST) done? (check all that apply) On-site, in the laboratory Sent to commercial lab Sent to affiliated hospital lab Other ______________________________ Unknown |
On-site, in the laboratory Sent to commercial lab Sent to affiliated hospital lab Sent to other local/regional, non-affiliated reference or public health laboratory (new collection) Other ______________________________ Unknown
(changed question number, updated question wording, added additional response option) |
New Instructions |
Answer the following questions for the lab selected in question 16. |
15) Is antifungal susceptibility testing available for any of the following antifungal drugs (check all that apply): Fluconazole Voriconazole Itraconazole Posaconazole Micafungin Anidulafungin Caspofungin Amphotericin B Flucytosine Other (specify) __________________ Unknown |
Fluconazole Voriconazole Itraconazole Posaconazole Micafungin Anidulafungin Caspofungin Amphotericin B Flucytosine Other (specify) __________________ Unknown
(changed question number) |
16) What methods are used for AFST? (check all that apply) Non-commercial broth microdilution YeastOne E test Vitek Other _________________ Unknown
C. albicans C. parapsilosis C. glabrata Other Candida spp. |
Non-commercial broth microdilution YeastOne E test Vitek Other _________________ Unknown
C. albicans C. parapsilosis C. glabrata Other Candida spp.
(changed question number) |
17) How are results of AFST reported? (select one) Categorical interpretation only (susceptible, resistant, etc.) MIC only Both--categorical interpretation PLUS MIC Unknown
CLSI M27 S4 CLSI M27 S3 From manufacturer of MIC test Apply epidemiologic breakpoints Other ____________________ |
Categorical interpretation only (susceptible, resistant, etc.) MIC only Both--categorical interpretation PLUS MIC Unknown
CLSI M27 S4 CLSI M27 S3 From manufacturer of MIC test Apply epidemiologic breakpoints Other ____________________
(changed question number) |
18) For what type of Candida isolates is antifungal susceptibility testing (AFST) performed automatically/reflexively? (check all that apply) Blood isolates Other normally sterile body site isolates Other (specify) ______________________ No AFST performed automatically (requires order from a clinician) Unknown |
Blood isolates Other normally sterile body site isolates Other (specify) ______________________ No AFST performed automatically (requires order from a clinician) Unknown
(changed question number) |
19) How is AFST performed for the following Candida spp.?
Performed automatically/reflexively (Go to 19ai) Performed with a clinician’s order Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
Performed automatically/reflexively (Go to 19bi) Performed with a clinician’s order Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
Performed automatically/reflexively (Go to 19ci) Performed with a clinician’s order Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
Performed automatically/reflexively (Go to 19di) Performed with a clinician’s order Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown |
Performed automatically/reflexively (Go to 21ai) Performed with a clinician’s order (Go to 21ai) Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
Performed automatically/reflexively (Go to 21bi) Performed with a clinician’s order (Go to 21bi) Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
Performed automatically/reflexively (Go to 21ci) Performed with a clinician’s order (Go to 21ci) Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
Performed automatically/reflexively (Go to 21di) Performed with a clinician’s order (Go to 21di) Not performed
Micafungin Anidulafungin Caspofungin Fluconazole Voriconazole Amphotericin B Other Unknown
(changed question number, changed skip logic question numbers in response options, updated question wording) |
Invasive Staphylococcus aureus (iSA) Laboratory Survey: Use of Nucleic Acid Amplification Testing (NAAT)
2020 Survey Question |
Proposed Changes Survey Question |
1. Do you set up culture for sterile sites (blood, CSF, bone, etc.) for Staphylococcus aureus on site (in-house at your laboratory? □ Yes - GO TO Q2 □ No
|
1. Do you routinely set up culture for sterile sites (blood, CSF, bone, etc.) on site (in-house at your laboratory? □ Yes - GO TO Q2 □ No – GO TO Q3 (updated question wording and skip pattern) |
1a. [if no} To which laboratory do you send sterile specimens for Staphylococcus aureus culture? |
1a. [if no] To which laboratory do you send sterile specimens for culture/identification? (updated question wording) |
|
2. Is S. aureus or MRSA routinely identified via culture-based methods on site (in-house) at your laboratory? □ Yes - GO TO Q3 □ No (added question) |
|
2a. [if no] To which laboratory do you send cultures for S. aureus identification? ___________________ (added question) |
2. Do you run any culture independent diagnostic tests (CIDT) for detection of S. aureus or MRSA either directly from a sterile source (CSF, Blood, etc.) or from a positive blood culture? □ Yes □ No - GO TO Q2d
|
3. Do you routinely run any culture independent diagnostic tests (CIDT) on site or at another lab for detection of S. aureus or MRSA either directly from a sterile source (CSF, Blood, etc.) or from a positive blood culture? □ Yes □ No - GO TO Q3d (updated question number, wording, and skip pattern) |
2a. [If yes] Do you run the CIDT on site or send out to another lab? □ On-site □ Send out, please specify lab __________________ |
3a. [If yes] Where is CIDT testing completed? □ On-site □ Send out, please specify lab __________________ - GO TO Q3c (updated question number, wording, and skip pattern) |
2b. Which CIDTs do you use (sterile site sources only, i.e. blood, CSF, pleural fluid, bone, etc.)? Please check all that apply. □ FilmArray® Blood Culture Identification Panel..Date started__________ □ Verigene® Gram-Positive Blood Culture Test…Date started__________ □ Verigene® Staphylococcus Blood Culture Test…Date started__________ □ Cepheid Xpert® MRSA/SA BC…Date started__________ □ BD Geneohm® StaphSR…Date started__________ □ AdvanDx Staphylococcus QuickFISH blood culture kit…Date started__________ □ AdvanDx S. aureus/CNS PNA FISH…Date started__________ □ Alere BinaxNOW® Staphylococcus aureus test…Date started__________ □ Great Basin Staph ID/R blood culture panel…Date started__________ □ T2Bacteria® Panel…Date started__________ □ Accelerate PhenoTest™ BC kit…Date started ________________ □ iCubate iC-GPC Assay™…Date started ________________ □ mecA XpressFISH® …Date started ________________ □ Micacom hemoFISH Masterpanel … Date started ________________ □ ePlex BCID-GP Panel … Date started ________________ □ Other, Lab Developed Test (detects MRSA or SA)… Date started ____________________ □ Other commercial test, Specify_______...Date started__________ |
3b. Which CIDTs do you use (sterile site sources only, i.e. blood, CSF, pleural fluid, bone, etc.)? Please check all that apply. □ FilmArray® Blood Culture Identification Panel..Date started__________ □ Verigene® Gram-Positive Blood Culture Test…Date started__________ □ Verigene® Staphylococcus Blood Culture Test…Date started__________ □ Cepheid Xpert® MRSA/SA BC…Date started__________ □ BD Geneohm® StaphSR…Date started__________ □ AdvanDx Staphylococcus QuickFISH blood culture kit…Date started__________ □ AdvanDx S. aureus/CNS PNA FISH…Date started__________ □ Alere BinaxNOW® Staphylococcus aureus test…Date started__________ □ Great Basin Staph ID/R blood culture panel…Date started__________ □ T2Bacteria® Panel…Date started__________ □ Accelerate PhenoTest™ BC kit…Date started ________________ □ iCubate iC-GPC Assay™…Date started ________________ □ mecA XpressFISH® …Date started ________________ □ Micacom hemoFISH Masterpanel … Date started ________________ □ ePlex BCID-GP Panel … Date started ________________ □ Other, Lab Developed Test (detects MRSA or SA)… Date started ____________________ □ Other commercial test, Specify_______...Date started__________ (updated question number) |
2c. [If using any of the above tests on sterile site specimens] Do you still obtain an isolate for S. aureus or MRSA? □ Yes □ No - GO to Q3 |
3c. [If using any of the above tests on sterile site specimens] Do you still obtain an isolate for S. aureus or MRSA? □ Yes □ No - GO to Q4 (updated question number and skip pattern) |
2d. [If no] Do you plan to start offering any CIDTs for S. aureus or MRSA within the next year? □ Yes □ No – END SURVEY |
3d. [If no] Do you plan to start offering any CIDTs for S. aureus or MRSA within the next year? □ Yes □ No – END SURVEY (updated question number) |
2e. When do you plan to start offering culture independent diagnostic tests? Month/Year: ____/____ |
3e. When do you plan to start offering CIDTs? Month/Year: ____/____ (updated question number and wording) |
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3f. Where do you plan to have CIDT tested? □ On-site □ Send out, please specify lab __________________ - END SURVEY (added question) |
3. How does your lab use the CIDT for detection of S. aureus or MRSA? (select one) □ Test concurrently with culture □ Reflex to culture after positive by CIDT panel □ Only run CIDT panel, no additional testing is done □ Other, specify _____________ |
4. How does your lab use the CIDT for detection of S. aureus or MRSA? (select one) □ Test concurrently with culture □ Reflex to culture after positive by CIDT panel □ Only run CIDT panel, no additional testing is done □ Other, specify _____________ (updated question number) |
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Comments (added comments field) |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Nti-Berko, Sonja Mali (CDC/DDID/NCEZID/DPEI) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |