The Antibiotic Resistance Laboratory Network

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1 The Antibiotic Resistance Laboratory Network 1

2 Antibiotic Resistance in the United States Sickens >2 million people per year Kills at least 23,000 people each year Plus 15,000 each year from C. difficile >$20B/year in healthcare costs Threatens modern medicine If we lose antibiotics, we lose the ability to treat patients with sepsis, cancer, provide organ transplants, and save victims of burns and trauma Need to act now or even drugs of last resort will soon be ineffective

3 Examples of Emerging AR Threats Pan-Resistant Gram-Negative Bacilli Enterobacteriaceae Acinetobacter spp. Pseudomonas aeruginosa Untreatable Neisseria gonorroheae Multi-Drug Resistant Candida spp. C. glabrata C. auris

4 Preventing AR Infections Works

5 Prevention Works

6 Prevention Guidelines

7

8 Coordinated Prevention Works Best State HAI/AR Prevention Programs Core capacity in all 50 states to detect, respond to, protect against HAI/AR threats Across all healthcare settings, networks of facilities in 25 states and 3 large cities working with health departments to: Better detect and respond to AR threats Prevent infections across healthcare

9 Detection Before Prevention

10 Lab Capacity Supported by the AR Solutions Initiative: Regional Labs Healthcare Labs State/Local Labs Regional Labs CDC

11 ARLN Data for Action Carbapenem-R Enterobacteriaceae (CRE) Interrupting CRE transmission in healthcare settings More accurate assess the burden of CRE Detect new or new trends in CRE types Carbapenem-R Pseudomonas aeruginosa and Acinetobacter spp. Detect plasmid-mediated carbapenemases ESBL-producing Enterobacteriaceae Detect mcr-1-mediated colistin resistance

12 ARLN Data for Action Salmonella spp. Measure the impact of antibiotic use in food-producing on human infections Neisseria gonorrhoeae Develop more accurate treatment guidelines Enhanced detect and response for new resistance in N. gonorrhoeae to identify and respond to outbreaks

13 ARLN Data for Action Candida spp. Detect resistance in strains that are not commonly Identification of C. auris and outbreak response Streptococcus pneumoniae Identify vaccine-escape strains Mycobacterium tuberculosis WGS to detect resistance and characterize transmission dynamics

14 Leveraging ARLN When New Threats Occur

15 More Resistant Bacteria and Bacteria that are Resistant to More Drugs An Example: 70 yo female hospitalized for an infection in her hip The patient recently traveled to India and was hospitalized for treatment of a hip fracture Infecting isolate: NDM-producing Klebsiella pneumoniae that was pan-resistant The patient developed septic shock and died

16 Leveraging technology and ARLN to identify therapeutic options for resistant infections.

17 Improved Communication of New AR Sends isolates with unusual resistance to ARLN Confirms & characterizes resistance. Initiates local prevention efforts CDC issues a national alert & sends alert to WHO WHO sends a global alert

18 In Conclusion

19 ARLN in Action Strategy and coordination for increased and sustained capacity Enhanced epi/lab collaboration at all levels Clinical lab partners for isolate sharing Improved communication among partners Improved coordination at CDC Rapid response for AR prevention EARLY SUCCESSES 556 suspected CRE Isolates: 194 Confirmed, 2 mcr-1 cases 5 CRE Colonization point prevalence surveys National infrastructure for detecting C. auris 1500 gonorrhea isolates: 300 sequenced, resistance trend tracking Nationally representative feasibility study of CIDT reflex culture Novel C. difficile data to interrupt transmission Enhancing national capacity for S. pneumoniae testing 19

20 National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) National Action Plan for CARB called for a CDC response to: Detect and -respond to resistant pathogens Prevent spread of resistant infections Encourage innovation for new strategies FY16: $160M appropriation will address AR with an ambitious, transformative approach, implementing CARB activities by 2020 For more information on CDC s key investments to combat antibiotic resistant bacteria, see:

21 Thank You Jean Patel

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