ABCs Case Report Form Instructions - Minnesota Department Of Health

QuestionT2. Date ofSpecimenCollection(2019)DefinitionIndicate the date of collection of first positiveculture and/or first positive CIDT, and everyinstance of positive culture and/or positiveCIDT from a different sterile source (e.g.blood vs CSF), within 30 days (8 days for S.pneumoniae)For culture positives: note this is NOT thedate when the culture was first noted to havegrowth.For cases positive CIDT and culture negativeor not done, record negative culture result.any.T3. Test Method(non-culture)(2019)T3a.Hospital/LabI.D. where testidentifiedIf positive CIDT, record specific test typeused, see options in SpecialInstructions/Notes column.ABCs laboratory unique identifier; this fieldrefers to the hospital or reference laboratorywhere the test was performed from a patientspecimen.7ABCs CRF InstructionsSpecial Instructions/NotesThis question replaces question ‘3b. Date of first positiveculture’ and ‘3c. Date of first positive Culture IndependentDiagnostic Test (CIDT, e.g. PCR) Collected’.Record each test in its own row.Exceptions:Do not record repeat positive cultures or CIDTs from samesource, unless the isolate from first positive culture or CIDTwas N/A for shipment to CDC, i.e. anything shipped to CDCneeds to be recorded on CRF.This question replaces ‘Q3d. Type of CIDT’.Options include:1 Biofire Filmarray Meningitis/Encephalitis Panel2 other3 Biofire Filmarray Blood Culture ID (BCID) Panel4 Verigene Gram Blood Culture (BCT) Test5 Bruker MALDI Biotyper CA System9 UnknownNote: Positive antigen test results (options 6-8) wereremoved from the form beginning in 2022.This question replaces ‘Q7a. Hospital/lab ID where cultureperformed’.Use the unique laboratory identifier - each laboratory shouldhave its own lab ID.Each ABCs site has its own system of assigning a unique IDto each hospital or lab. The hospital/lab ID will be assignedby ABCs personnel and matches the coding scheme used forcore MRSA.

T4. Site fromwhich organismisolated(2019)Indicate sterile site(s), i.e. multiple sources,from which the ABCs organism was isolated.This field captures sterile and some nonsterile sources (for the GAS and HiNSESspecial exceptions).ABCs CRF InstructionsThis question replaces ‘Q13. Sterile sites from whichorganism isolated’, ‘Q13b. CIDT Sterile Site from whichOrganism Detected’ and ‘Q14. Other sites from whichorganism isolated’. However,For Sterile Site Questions: Resource: Table 2To be an ABCs case, there must be a report ofClarifications:isolation or detection of an ABCs pathogenA case report form is generated only when the pathogen isfrom a sterile source (i.e. Blood, CSF, etc.).isolated from one of the sterile sites listed in the optionsbelow, regardless of whether the pathogen is also isolatedIf isolated from other normally sterile site,from one of these other sites. There is one exception:please specify the site in the “other, specify”field.Exception: If GAS is isolated from a wound ANDaccompanied by necrotizing fasciitis (NF) or streptococcalIn September 2018, ABCs sites begantoxic shock syndrome (STSS), it is considered a case and adetermining sterility of questionable sites.case report form should be completed. If the above is trueFor extraordinary situations, sites mayconsult with CDC ABCs personnel to make a for a GAS case, remember to check off either NF or STSS in‘Types of Infections’ for question 26.determination on whether a source is sterileor not.Starting 2018, the special exception for GBS isolated fromthe placenta and/or amniotic fluid only when a fetal deathFor core ABCs, URINE and SPUTUM areoccurs no longer applies.never considered sterile sites.Note: Amniotic fluid (Option 21) and Placenta (Option 24)as non-sterile site options were removed from the formbeginning in 2022.Clarifications for sterile sites:Do not record ambiguous and non-specific sources (i.e. fluid,abscess, tissue, aspirate, etc.) as sterile sites. To beconsidered a sterile site for ABCs, additional information onthe actual location within the body needs to accompany thereported source. Examples of how to report these include:abdominal abscess, deep leg tissue, groin aspirate, etc. Note:this differs from core MRSA where the only acceptable‘other’ sterile site entries are “fluid (sterile)” and “deeptissue”.Cultures from bowel are NOT considered sterile for anyABCs organism; however, peritoneal fluid is. If an ABCspathogen is cultured from peritoneal fluid, it will beconsidered a sterile site, even in the presence of a perforatedbowel. (Note: this differs from core MRSA.)While superficial skin abscesses do not meet the sterile sitecriteria, an abscess specimen obtained from a normallysterile body site will be counted as a case for surveillance. Ifthe abscess is obtained from one of the organs/body sites inthe pick list the body site should be used for this field (e.g., abrain abscess should be coded as “brain”). If the abscess isobtained from a body site that is not in the pick list, pleaselist the site and write the word “abscess” in the “other,specify” field (“abscess” alone is not an acceptable sterilesite).8

QuestionABCs CRF InstructionsDefinitionSpecial Instructions/NotesSpecimens from superficial skin infections (e.g. superficialskin abscesses, boils, furuncles or specimens from amnioticfluid, appendix, aqueous fluid, catheter, cord blood, cornea,gallbladder, lung, middle ear, placenta, sinus (all types),sputum, throat, or urine) are NOT considered sterile sites forany ABCs organism and should not be indicated as the onlyspecimen from which the pathogen was isolated.If the culture is taken 12 hours after death, autopsyspecimens may be considered sterile sites. Autopsyspecimens should be discussed with CDC on a case-by-casebasis. Cultures taken 12 hours after death will not beconsidered sterile site cultures for ABCs.Select ‘Blood’ for tests using a positive blood culture (e.g.Filmarray BCID panel).Options include:Sterile Sites1 Blood2 Bone3 Brain4 CSF5 Heart6 Joint7 Kidney8 Other Sterile Site9 Unknown10 Liver11 Lymph node12 Muscle/Fascia/Tendon (GAS only)13 Ovary14 Pancreas15 Pericardial Fluid16 Peritoneal Fluid17 Pleural fluid18 Spleen19 Vascular Tissue20 Vitreous fluidNon-Sterile Sites27 Wound (GAS w/NF or STSS only)9

QuestionT5. Bacterialspecies isolatedDefinitionIndicate invasive ABCs organism isolated.Specify (if any) non-ABCs organismsidentified from the same sterile source andthe same culture date as the first positiveinvasive ABCs culture.ABCs CRF InstructionsSpecial Instructions/NotesThis question replaces ‘Q12a. Bacterial species isolated fromany normally sterile site’ and ‘Q12b. Other bacterial speciesisolated from sterile site’.If a case has more than one invasive ABCs organismisolated, separate state IDs must be assigned, separate CRFsmust be completed for each organism, and each enteredindividually into the database.Options*:1 Neisseria meningitidis2 Haemophilus influenzae3 Group B Streptococcus5 Group A Streptococcus6 Streptococcus pneumoniae* For other bacterial pathogens (i.e. non-ABCs) write-inpathogen name (see data dictionary for full list of codedoptions).T6. Test ResultIndicate result of the test performedThis replaces ‘Q3a. Was a culture performed?’Options:1 Positive0 NegativeT7. IsIsolate/SpecimenAvailable?(2018)T8. Ifisolate/specimennot available,why Not?Indicate whether an isolate or specimen (ifCIDT positive only) is available for theABCs case. If not available, record thereason why in T8.Resource: Isolate, Specimen Shipping ProtocolThis question replaces ‘Q15. Is isolate available?’Previously collected on Isolate Form.For cases where ABCs pathogen is isolated from multiplesources, refer to the isolate shipping protocol for guidanceon the algorithm for choosing one isolate.Indicate the reason the isolate/specimen wasnot available.For CIDT cases, defined as positive CIDT and negative orculture not done please attempt to obtain and ship anyspecimen (including blood bottle or aliquot) to CDC.This question replaces ‘Q15b. If isolate not available, whynot?’Options available:1 ‘N/A at Hospital Lab’ – if the hospital or reference lab hasdiscarded the isolate and it was never sent to the state lab.Previously collected on Isolate Form.(2018)2 ‘N/A at State Lab’ – if the state lab has discarded theisolate3 ‘Hospital refuses’ – if the hospital refuses to send theisolate to the state lab and/or CDC4 ‘Isolate Discrepancy (2x)’ – if the isolate has beenshipped to CDC at least twice and both times resulted as apathogen different from the clinical lab result.10

QuestionABCs CRF InstructionsDefinitionSpecial Instructions/Notes5 ‘No DNA’ – if sent as non-viable or later found to be nonviable by CDC and upon PCR, no DNA was found.6 ’Isolate Not Needed’ – this option to be used for situationswhere the isolate is normally not requested from thehospital/reference lab.T9. Shipped toCDC?Indicate whether the isolate (if available) wasshipped to CDC.T10. If shipped,accession #16. Was patienthospitalized?Record SPHL accession # for isolatesshipped to CDC.Indicate whether or not the patient washospitalized at an acute care facility duringthis event. If appropriate, indicate the dates ofadmission and discharge.17. If patient washospitalized, wasthis patientadmitted to theICU?Only select an option if Isolate available ‘Yes’Options:1 Yes0 NoFor cases that die during hospitalization: if the date of deathand the discharge date differ, enter the date of death.Additional notes on hospitalization status: ER visits and outpatient visits are notIf a case is transferred from another hospital,hospitalizations. If the patient is admitted to anplease use the date of admission from the firstacute care facility following an ER or outpatienthospital and use the date of discharge fromvisit then the patient has been hospitalized.the second hospital. If the patient is admitted For a patient to be considered hospitalized, thethrough the ER into an acute care hospital,culture date should occur no more than 7 daysthe date of admission is the date of the ERbefore hospital admission date. Note: starting invisit. NOTE: if case was a patient on a non2012, this rule applies to core ABCs only. MRSAmedical ward when the culture was collectedsurveillance has expanded their definition to 30(see 18a), list the admission and dischargedays from initial culture date.dates for the acute care portion of the hospital A case would not be considered hospitalized for astay only.particular illness episode if the culture date is afterthe hospital discharge date.If patient is discharged from the hospital to a A case would not be considered hospitalized iflong-term care facility or hospice, OR, if theadmitted for a 24-hour observation period only. Apatient was transferred to a long term carecase would be considered hospitalized if admittedunit (e.g., skilled nursing care unit orfor 24 or more hours in an observation unit or ER.hospice) within the hospital, use this date of If a person left the hospital against medical advicetransfer as the date of discharge. In this(AMA) and was readmitted for care (related to thatinstance, the discharge date from this type ofsame infection) within 24 hours count as part of thelong-term care facility or hospice shouldsame hospitalization. If the readmission was 24NOT be used. Likewise, if a patient ishours then it would not be count as part of the sameadmitted from a long-term rehabilitation orhospitalization. Should further clarification bespecialty unit, other long-term care facility orneeded, please contact CDC.hospice, please use the date or transfer to theacute care facility as the date of admission.Indicate if patient was admitted to theOther specialty units such as MICUs (medical intensive careintensive care unit (ICU) during thisunit), SICU (surgical ICU), PICU (pediatric ICU), NICUhospitalization.(neonatal ICU) and CCU (cardiac care unit) are consideredICUs. Please note these are examples only and do notconstitute an exhaustive list of ICUs.A step-down unit is not considered an ICU for ABCs.11

Question18a. Where wasthe patient aresident at timeof initial culture?ABCs CRF InstructionsDefinitionIf known, indicate where patient was aresident at time of initial culture.Special Instructions/NotesResources: Table 3Do NOT answer this question if the case is between theages of 0-89 days. This is inclusive of all ABCs pathogens(per change made at beginning of surveillance year 2012).Note: The specify field will NOT be transmitted to CDC andwill NOT be added to the database. This is for site use only.Core MRSA: This question is not equivalent to question 5 onthe core MRSA CRF.For persons experiencing homelessness (PEH), see Table 3for specific instructions on how to complete Q18a.18b. If residentof a facility,what was thename of facilityFacility IDIf patient was a resident of a facility (i.e., along term care facility or, if the informationis desired by ABCs site, any type of chroniccare facility) at the time of the ABCs illness,enter the name of the facility here.Additionally, record the Facility ID assignedto that facility.19a. Was patienttransferred fromanother hospital?Indicate if patient was admitted to andtransferred from another acute care hospitalprior to receiving treatment at the hospitalwhere the chart is being reviewed.19b. TransferHospital ID20a. WeightThe acute care hospital from which thepatient was transferred.Indicate weight in pounds (lbs) and ounces(oz) OR in kilograms (kg). Please recordweight only in pounds OR kilograms, notboth.Resource: HAIC/ABCs Facility Classifications documentName of facility is NOT transmitted to CDC. However, theFacility ID is transmitted to CDCAssigning an unknown facility ID: If the exact facility that apatient has been in or was discharged to is unavailable – Donot leave the Facility ID blank, assign a placeholder such as“UNK LTCF” as the facility ID.If the patient was admitted from a long-term care facility, seespecial instructions for question 16 above.Please note that birthing centers do not qualify as a hospitalsetting. If an infant is transferred from a birthing center to ahospital, check “no” to this question.Please note the name of the hospital; the hospital ID will beassigned by ABCs personnel.If multiple weights are in chart, use weight recorded atadmission.20b. HeightIndicate height in feet (ft) and inches (in) ORin centimeters (cm).If weight is recorded with a decimal number and the decimalnumber is between 0.1 and 0.4, round down to the nearestwhole number. If the decimal number is between 0.5 and0.9, round up to the nearest whole number. For example.135.7 lbs should be recorded as 136 lbs and 213.2 lbs shouldbe recorded as 213 lbs.If multiple heights are in chart, use height recorded atadmission.20c. BMIBody mass index; preferentially record heightand weight.Record BMI ONLY if height, weight or both areunavailable.12

Question21. Type ofinsuranceDefinitionCheck ALL types of insurance as noted in thehospital chart. If a patient’s insurance statuschanges during hospitalization, indicateinsurance status at admission.ABCs CRF InstructionsSpecial Instructions/NotesResources: Table 4 and Table 4.2Clarification: Some private companies partner with someform of state assistance program, Medicaid, and/orMedicare. In this case, please check both “private” andadditional “public” health insurance type. This includes anyMedicare Advantage plan (See Tables 4 & 4.2 for more infoon MA plans). As an example, ‘Medi-Gap’ would berecorded as both “Medicare” and “Private”. If the MA planis not documented as private or public (or both), record thisin the ‘other’ field.If the chart notes “self pay”, check “uninsured”. (changemade in 2012)22. Outcome22a. If survived,patientdischarged to:(select option)Hospitalized patients: indicate the patient’soutcome as either “Survived” (patient wasdischarged alive), or “Died” (patient diedduring acute hospitalization) upon discharge.Check “Unknown” if the chart is incompleteor if it is not clear from the medical record.Non-hospitalized patients: indicate thepatient’s outcome as “Survived” (patient leftthe ER/outpatient clinic or dialysiscenter/office alive) or “Died” (patient diedwhile seen at the ER/outpatient clinic ordialysis center/office). Check “Unknown” ifthe chart is incomplete or it is not clear fromthe information available.Indicate where patient was discharged to ifdischarged alive.(2016)If questions arise in the field on insurance types, pleasecontact CDC for further guidance.Clarification: If the patient was seen in the ER or outpatientoffice and was alive upon leaving the ER or office, mark“survived” even if they died shortly after.Resource: Table 3For information on when to check ‘LTC/SNF’ or ‘LTAC’options, refer to instructions and examples in the ‘FacilityClassification Instructions’ and/or refer to Table 3.“Left AMA” (left against medical advice) (2019) – choosethis option if case was hospitalized and leaves beforemedically discharged. If patient not hospitalized, this optiononly applies to ER visits and is not applicable to outpatientvisits.For persons experiencing homelessness (PEH), see Table 3for specific instructions on how to complete Q22a.23. If patientdied, was initialculture obtainedfrom autopsy?This question should be answered only forcases who have died or OUTCOME 2.13Reminder: autopsy specimens may be considered sterile sitecultures only if the culture is taken 12 hours after death.

Question24a. At the timeof first positiveculture, was thepatient pregnantor postpartum?24b. If pregnantor postpartum,what was theoutcome of thefetus?DefinitionIndicate whether the patient was pregnant orpostpartum at the time of collection of thefirst positive invasive culture. For thissurveillance project, the postpartum period isdefined as the 30 days following a deliveryor miscarriage. Check “Neither” if a) there isspecific mention of a negative pregnancy test,or that the patient is not pregnant, or b) theentire chart was reviewed and

8. Date of birth Patient's date of birth. Use 4 -digit year (i.e., mm/dd/yyyy) 9a. Age Patient's age at the time of collection of the first positive invasive culture. If patient's age is 30 days, indicate age in days. If patient's age is 30 days to 11 months, indicate age in months. If patient is 12 months or older, indicate age in years.