Hello! My question is about how to deal with mapping of classes of antibiotics. In a local catalogue they have test codes for Amdinopenicillins, Aminocyclitols, and so on.
Best,
Maria
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Hi Maria,
Do you have more detail so we can help answer your question. Are these for antimicrobial sensitivty testing or drug levels in toxicology or ? Aminocyclitols include aminoglycoside antibiotics: Aminocyclitol - Wikipedia There are also allergy tests for aminoglycosides too: LOINC 95953-6 Aminoglycoside Mix (Gentamicin+Lincomycin+Neomycin+Streptomycin+Tobramycin) IgE Ab [Units/volume] in Serum
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Hi Andrea,
they are antimicrobial sensitivity tests. Thanks for your help!
Best,
Maria
Hello,
Thank you for the information.
Reviewing some mapping and testing principles. Please advise if these don’t apply to your scenario. If the laboratory testing is for a specific antibiotic including a subtype of the antibiotics you mentioned, the test result should be mapped to the specific LOINC for that antibiotic. Given you mentioned a “class” of antibiotics, it sounds like the test is for any one of the antibiotics in the class but doesn’t specify which one. See: https://academic.oup.com/jac/article/16/5/555/701118 Typically the test is for a subtype or specific antibiotic as susceptibilities often vary within a “class” amongst the different antibiotics and organism combinations tested. Indeed we see differerent CLSI standards requirements for reporting in this regard too. One other aspect is much medical vernacular uses generic terms without specifying details such as specimen or method that can result in clinically signifcantly different interpretations. These are also different from the details in test builds and thus mapping (and why there are so many different LOINCs including a number for the same analyte, antibiotic, etc.)
Are the Aminocyclitols tested limited to only those that are Aminoglycosides or do they include Aminoglycosides and other aminocyclitols? How is the susceptibility test reported? Assuming it is not the genotype since not mentioned? If Aminoglycoside only and Ord or Qn, then LOINC 100041-3 Aminoglycoside [Susceptibility] may be the appropriate LOINC. In the event that your antibiotics include more than just aminoglycosides, you may need to request a LOINC for your test details as there are no LOINCs I see for Aminocyclitols.
I also assume you mean Aminopenicillins (no d)? There is no LOINC for this higher level “grouping” as testing is typically performed on the subtypes of penicillins. See https://www.sciencedirect.com/topics/medicine-and-dentistry/aminopenicillin When looking at LOINCs for penicillin (as there are no LOINCs for Aminopenicillins or penicillins), there are LOINCs for subtypes like V or G, and whether it is parenterally administered. LOINC 18964-7 Penicillin [Susceptibility] is the methodless Penicillin LOINC.
Penicillins are also a subtype, amongst others, of Beta Lactam antibiotics, including “extended-spectrum β-lactamases (ESBLs).” See β-Lactams and β-Lactamase Inhibitors: An Overview - PMC If your testing focuses on Beta lactamases, then LOINC 6984-9 Beta lactamase.extended spectrum [Susceptibility] may be appropriate.
There are also quite a few molecular tests on resistance gene testing for these antibiotics and classes too.
Unfortunately, not ensough information has been shared to offer a definitive LOINC mapping.
Cordially,
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Hi Andrea,
thank you for your long and detailed response. Some passages of it perhaps contain the exact answer to my question. Specifically, knowing that the basic principle of LOINC is to map at the highest possible level of detail so as not to lose the specificity of clinical information, I was wondering whether for antimicrobial sensitivity testing, only specific antibiotics or classes including multiple specific antibiotics could be mapped. Perhaps the best-known example is that of macrolides: do we map only Erythromycin, Clarithromycin, Azithromycin, Spiramycin, etc., or do we also map a “macrolide” test code? If the answer is only specific antibiotic entries, then I wonder when the code you mention for Aminoglycosides ( LOINC 100041-3 Aminoglycoside [Susceptibility] ) is used (which I actually used in the corresponding test catalog entry too). To add more detail: all tests in this catalog have the Susc, Scale OrdQn, and System Isolate properties. Thank you for your invaluable help!
Maria
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