Lab Matters Summer 2019 - Page 77

APHL 2019 POSTER ABSTRACTS mediated colistin resistance genes. The data demonstrate a very specific assay, with no observed cross-reactivity with previously characterized clinical isolates from Gram-negative organisms. Future studies will evaluate the clinical sensitivity of the assay. The results demonstrate this assay can serve as a screening tool for surveillance of this mcr-mediated colistin resistance, thereby improving antimicrobial stewardship practices to minimize mcr gene dissemination into the community. Presenter: Esther Alao, Streck, La Vista, NE, CDC is currently supporting ETOR expansion efforts, and this initiative needs to be more widely understood and normalized in order to be adopted by public health at large. Presenter: Rachel Shepherd, Association of Public Health Laboratories, Silver Spring, MD, Informatics that can benefit from ETOR. This poster will also explore the issues that laboratories need to consider before developing ETOR capacity, especially around the sometimes neglected but critical area of partner engagement and will examine how to broker conversations with submitters around issues like: Submitter access, Message standard, Defined vocabulary, Security requirements, Billing coordination. Electronic Laboratory Reporting for Animal Rabies Newborn Screening K. Higginbotham 1 , D. Sanderson 2 , R. Merrick 2 ; 1 Alabama Department of Public Health, 2 Association of Public Health Laboratories Evaluation of Free Carnitine (C0) Cutoffs in Newborn Screening Currently, most public health laboratories are either not reporting or sporadically reporting data for animal rabies in a variety of manual ways, in a manner that hasn’t changed in decades. Calls back and forth between laboratories and providers, the mailing and filing of paper results, as well as the logging of those results, often in multiple spreadsheets or databases, all take a toll on laboratory productivity. Electronic laboratory reporting (ELR) can be an invaluable tool in reducing time hours and time delays throughout the notification process, which is especially critical when dealing with time-sensitive information. In this poster, we will examine the benefits of ELR, using Animal Rabies reporting as a case study and looking at Alabama State Public Health Laboratory’s transition. Over the last two years, APHL has been providing technical assistance to laboratories to allow them to electronically report, in real-time or near real-time, Animal Rabies data using a standardized vocabulary and message format. This reporting works alongside laboratories’ existing mechanism for reporting to the state epidemiologists. APHL has assisted several labs in electronically reporting to CDC, including Kansas State University, Alabama State Public Health Laboratory, and Kentucky State Public Health Laboratory. PHL, and is currently working with Georgia, Montana, South Carolina, Virginia, and West Virginia. This poster will also showcase how other laboratories can take advantage of this free technical assistance to electronically report Animal Rabies messages. Presenter: Rachel Shepherd, Association of Public Health Laboratories, Silver Spring, MD, Making the Most of ETOR K. Higginbotham1, S. Johnson2, I. Duduk3, M. Wedig4, B. Matthis5, N. Sankrithi6; 1Alabama Department of Public Health, 2Missouri State Public Health Laboratory, 3Texas Department of State Health Services, 4Wisconsin State Laboratory of Hygiene, 5Philadelphia Department of Public Health, 6Massachusetts Department of Public Health This poster will demonstrate the necessary steps and minimum requirements of a laboratory to utilize Electronic Test Orders and Results, as well as showcase the range of scenarios in a laboratory PublicHealthLabs @APHL O. Adair, S. Hall, T. Washington and R.B. Dixon, South Carolina Department of Health & Environmental Control Introduction: Newborn screening (NBS) laboratories are involved in high-throughput and high-impact testing. To serve the needs of this critical patient population, it is necessary to have accurate testing and effective cutoffs. Developing cutoffs is challenging due to diverse populations, gestational age and other factors. Nonetheless, it is essential for appropriate test interpretation. Methods: This poster abstract will focus on the evaluation of an analyte which serves as a screening biomarker in the newborn screening laboratory. Tools such as Collaborative Laboratory Integrated Reports (CLIR) available at provide an additional multivariate algorithm to evaluate screening test results. The information from CLIR allows laboratories, NBS Follow Up staff and medical specialists to evaluate the results in context of additional screening analytes and factors such as birth weight. The unique feature of free carnitine (C0) is that it has both an upper and lower cutoff. Due to this characteristic, both scenarios must be evaluated. In order to perform this evaluation, data from over 3 months was studied at the upper cutoff and lower cutoff. In this poster, we will outline the key parameters evaluated and a summary of the results. Preliminary data: The intent of our study is to provide accurate screening in a way that reduces false positives while minimizing false negatives. The Newborn Screening conditions considered in the study as indicated by the free carnitine (C0)0 biomarker include carnitine palmitoyltransferase 1 (CPT-1) deficiency and carnitine uptake defect (CUD). We applied CLIR to the results in the study to evaluate the threshold for lower and upper cutoffs. Second tier DNA analysis results were included for screen positive results to confirm or rule-out disease. The information derived from the initial study obviated that both confirmed negatives and confirmed positive samples are needed to effectively modify laboratory cutoffs. While this is unsurprising, it remains a significant challenge for NBS programs due to the rare nature of particular disorders. Our next steps will be to obtain feedback from clinical specialists regarding the information from this study. Ongoing efforts will be made to compile observations to better support cutoff evaluation and adjustment. Summer 2019 LAB MATTERS 75