Last updated: May 17, 2017

The goal of this project is to create a web application that can be used by clinicians at Johns Hopkins Bayview Medical Center in order to provide antibiotic recommendations for patients affected by common infections.

• Students: Katie Hochberg and Allie Sanzi
• Mentors: Jennifer Townsend, Michael Cohen, and Andrew Hinton

Centers for Disease Control and Prevention estimates that “up to 50% of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed.” This overuse of antibiotics is a dangerous issue facing healthcare in the United States and other countries around the world. It leads to antibiotic resistance, meaning that the usual treatments for infections are no longer effective, and alternative treatments must be used. These alternative treatments are more expensive, less effective, and/or result in a greater cost to the patient. To improve the accuracy of antibiotic prescription, Antibiotic Ninja will assist healthcare providers by making an appropriate antibiotic recommendation for patients based on their history, vital signs, and lab results.

• Minimum: Completed
  1. Documentation including use cases and exploration of external API’s
  2. Backend design for database, admin portal, and user portal

• Expected: Completed
  1. Backend implementation for database, admin portal, and user portal
  2. Frontend implementation for admin portal and user portal
  3. Minimum viable product for testing at Bayview Medical Center

• Maximum: Completed
  1. User Interface enhancements
  2. Decision Tree GUI Implementation Plan

We are building a web application to give decision support to doctors when prescribing antibiotics. Our advisor, Dr. Jenny Townsend, has developed decision trees that healthcare providers follow when diagnosing a suspected infection patient. These decision trees will inform the underlying database structure and flow of our application. The web application will have an administrator portal, which will allow administrators to customize these decision trees, and a user portal, which will allow healthcare providers to enter patient health data as prompted and receive an antibiotic recommendation. The first thing we plan to do is explore the documentation of the external APIs that we will need to use. This will allow us to understand the interactions between our application and the external APIs so that we can create an effective design. We will continue by designing the schema for the database as well as the backend of the application. For the database, we will use a PostgreSQL database. For the rest of the stack, we will use Node.js, Express.js, and Angular.js. After creating a design for the backend, we will implement the backend of the application using iterative testing to ensure proper function. As we implement the backend, we will work with the team to turn the UI wireframes into a complete design. We will then build out the frontend of the application and create a clean user interface that is intuitive to use. If time permits, we will enhance the user interface and create an implementation plan for a graphical user interface to build decision trees.

1. Use Cases and Documentation
   • Completion Date: March 5, 2017
   • Status: Completed
2. Backend Design
   • Completion Date: March 6, 2017
   • Status: Completed
3. Backend Implementation
   • Planned Date: April 11, 2017
   • Expected Date: April 11, 2017
   • Status: Completed
4. Frontend Implementation
   • Planned Date: April 25, 2017
   • Expected Date: April 25, 2017
   • Status: Completed
5. Enhancing User Interface
   • Planned Date: May 9, 2017
   • Expected Date: May 9, 2017
   • Status: Completed
6. Decision Tree GUI Implementation Plan
   • Planned Date: May 9, 2017
   • Expected Date: May 9, 2017
   • Status: Completed

• Project Plan
  • Project plan presentation
  • Project plan proposal
• Project Background Reading
  • See Bibliography below for links.
• Project Checkpoint
  • Project checkpoint presentation
• Paper Seminar Presentations
  • Katie Hochberg Seminar Paper
  • Katie Hochberg Seminar Presentation
  • Allie Sanzi Seminar Paper
  • Allie Sanzi Seminar Presentation
• Project Final Presentation
  • PDF of Poster
• Project Final Report
  • Final Report

• CDC. Antibiotic Resistance Threats in the United States, 2013. Vol CS239559-B. Atlanta, GA 2013:114.
• Pollack LA, Srinivasan A. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clin Infect Dis. 2014;59 Suppl 3:S97-100.
• Magill SS, Edwards JR, Beldavs ZG, et al. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014;312(14):1438-1446.
• Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of healthcare-associated infections. N. Engl J Med. 2014;370(13):1198-1208.
• Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med. 2003;163(8):972-978.
• Braykov NP, Morgan DJ, Schweizer ML, et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. Lancet Infect Dis. 2014;14(12):1220-1227.
• MacDougall C, Polk RE. Variability in rates of use of antibacterials among 130 US hospitals and risk- adjustment models for interhospital comparison. Infect Control Hosp Epidemiol. 2008;29(3):203-211.

• Project Files
  • Use Cases and Backend Design Document
  • Frontend Design Document
  • GUI Implementation Plan
• Other Resources
  • BitBucket repository

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